Compstatin and analogs thereof for eye disorders

ABSTRACT

The present invention features the use of compstatin and complement inhibiting analogs thereof for treating and/or preventing age related macular degeneration and other conditions involving macular degeneration, choroidal neovascularization, and/or retinal neovascularization. The invention also provides compositions comprising compstatin or a complement inhibiting analog thereof and a second therapeutic agent. The invention also provides compositions comprising compstatin or a complement inhibiting analog thereof and a gel-forming material, e.g., soluble collagen, and methods of administering the compositions.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of application Ser. No. 11/544,389,filed Oct. 6, 2006, which claims priority to and the benefit ofprovisional applications U.S. Ser. No. 60/725,484, filed Oct. 8, 2005,U.S. Ser. No. 60/726,447, filed Oct. 12, 2005, and U.S. Ser. No.60/760,974, filed Jan. 19, 2006, all of which are incorporated herein byreference.

SEQUENCE LISTING

In accordance with 37 CFR §1.52(e)(5), the present specification makesreference to a Sequence Listing (submitted electronically on Jul. 18,2013 as a .txt file named “SeqListing.txt” in parent application Ser.No. 11/544,389, filed Oct. 6, 2006). The .txt file was generated on Jul.15, 2013 and is 14 kb in size. The entire contents of the SequenceListing are herein incorporated by reference.

BACKGROUND OF THE INVENTION

The macula is a small area in the retina of the eye, approximately 3 to5 millimeters in size, adjacent to the optic nerve. It is the mostsensitive area of the retina and contains the fovea, a depressed regionthat allows for high visual acuity and contains a dense concentration ofcones, the photoreceptors that are responsible for color vision.

Macular degeneration is a term that refers to a number of differentdiseases characterized by degenerative changes in the macula, all ofwhich lead to a loss of central vision. Age-related macular degeneration(ARMD) is the most common cause of functional blindness in developedcountries for those over 50 years of age (Seddon, J M. Epidemiology ofage-related macular degeneration. In: Ogden, T E, et al., eds. Ryan S J,ed-in-chief. Retina Vol II. 3rd ed. St. Louis, Mo.: Mosby;2001:1039-50). The disease is characterized by progressive degenerationof the retina, retinal pigment epithelium (RPE), and underlying choroid(the highly vascular tissue that lies beneath the RPE, between theretina and the sclera). The retinal pigment epithelial layer is believedto be crucial for photoreceptor health. Cells in this layer recyclevisual pigment (rhodopsin), phagocytose photoreceptor tips daily as partof rod and cone regeneration, and transport fluid across the membrane tothe choroid, which is believed to help prevent detachment of the neuralretina. Central vision deteriorates when cells in the RPE cease tofunction properly, which can lead to photoreceptor degeneration.

A variety of factors including oxidative stress, inflammation with apossible autoimmune component, genetic background (e.g., mutations), andenvironmental or behavioral factors such as smoking and diet maycontribute to the pathogenesis of ARMD in ways that are as yet not fullyunderstood. Regardless of the underlying etiology, a clinical hallmarkof ARMD is the appearance of drusen, localized deposits oflipoproteinaceous material that accumulate in the space between the RPEand Bruch's membrane, which separates the RPE from the choroidal vessels(choriocapillaris). Drusen are typically the earliest clinical findingin ARMD, and the existence, location, and number of drusen are used inclassifying the disease into stages and for monitoring its progression(Ambati, J., et al., Surv. Ophthalmol., 48(3): 257-293, 2003; “PreferredPractice Pattern: Age-Related Macular Degeneration”, American Academy ofOphthalmology, 2003). Drusen are typically the earliest clinical findingin ARMD.

ARMD has been classified into both “dry” and “wet” (exudative, orneovascular) forms. Dry ARMD is much more common than wet ARMD, but thedry form can progress to the wet form, and the two occur simultaneouslyin a significant number of cases. Dry ARMD is typically characterized byprogressive apoptosis of cells in the RPE layer, overlying photoreceptorcells, and frequently also the underlying cells in the choroidalcapillary layer. Confluent areas (typically at least 175 μm in minimumdiameter) of RPE cell death accompanied by overlying photoreceptoratrophy are referred to as geographic atrophy. Patients with this formof ARMD experience a slow and progressive deterioration in centralvision.

Wet ARMD is characterized by bleeding and/or leakage of fluid fromabnormal vessels that have grown from the choroidal vessels(choriocapillaris) beneath the RPE and the macula, which can beresponsible for sudden and disabling loss of vision. It has beenestimated that much of the vision loss that patients experience is dueto such choroidal neovascularization (CNV) and its secondarycomplications. A subtype of neovascular ARMD in which angiomatousproliferation originates from the retina and extends posteriorly intothe subretinal space, eventually communicating in some cases withchoroidal new vessels has been identified (Yannuzzi, L. A., et al.,Retina, 21(5):416-34, 2001). This form of neovascular ARMD, termedretinal angiomatous proliferation (RAP) can be particularly severe. Theexistence of macular drusen is a strong risk factor for the developmentof both wet and dry forms of ARMD (Ambati, J., et al., supra).

Treatment options for ARMD are limited, and none are fully effective(Ambati, J., et al., Surv. Ophthalmol., 48(3): 257-293, 2003, andreferences therein). Thus there is a need in the art for new approachesto the treatment of ARMD and also of other diseases and conditions ofthe eye characterized by macular degeneration, choroidalneovascularization, retinal neovascularization, retinal angiomatousproliferation, and/or blood vessel leakage. Such diseases and conditionsinclude, but are not limited to, diabetic retinopathy and retinopathy ofprematurity. There is also a need in the art for new approaches to thetreatment of eye disorders characterized by ocular inflammation.

SUMMARY OF THE INVENTION

The present invention addresses the foregoing needs, among others. Theinvention provides a method of treating an eye disorder comprising (i)providing a subject in need of treatment for the eye disorder; and (ii)administering a composition comprising a compstatin or a complementinhibiting analog thereof to the subject. Any of a wide variety of eyedisorders can be treated. For example, disorders characterized bymacular degeneration, choroidal neovascularization, retinalneovascularization, ocular inflammation, or any combination of these,can be treated.

The invention further provides a composition comprising: (i) compstatinor a complement inhibiting analog thereof; and (ii) a moiety that bindsto a component present in the eye of a subject at risk of or sufferingfrom an eye disorder characterized by macular degeneration, choroidalneovascularization, retinal neovascularization, ocular inflammation, orany combination of these. The component can be a cellular marker or anoncellular entity, e.g., a molecule or complex that is present indeposits found in the eye of a subject with macular degeneration, ocularinflammation, etc.

The invention further provides a composition comprising: (i) compstatinor a complement inhibiting analog thereof; and (ii) an angiogenesisinhibitor.

The invention further provides a composition comprising a plurality ofcompstatin analog molecules, or moieties, attached to a polymericbackbone or scaffold or a multimer of compstatin molecules and/orcompstatin analogs. The compstatin analog moieties may be identical ordifferent. The composition may contain, e.g., 2, 3, 4, or more differentcompstatin analogs attached to a polymeric backbone or scaffold.

The invention further provides a composition comprising: (i) compstatinor a complement inhibiting analog thereof; and (ii) a solublegel-forming material. The composition forms a gel following introductioninto the body, e.g., upon contact with a physiological fluid. In oneembodiment, the compstatin analog is attached to a polymeric backbone orscaffold. In one embodiment, the composition comprises a plurality ofcompstatin analog molecules linked to one another. In certainembodiments of the foregoing compositions, the soluble gel-formingmaterial is soluble collagen. The composition may further comprisefibrillar collagen solids. In certain embodiments of the invention anyof the compositions comprising a soluble gel-forming material furthercomprises an angiogenesis inhibitor. The composition may be formed intoa gel implant in vitro and administered to, or in the vicinity of, theeye.

The invention further provides ocular implants and polymeric deliveryvehicles comprising compstatin or a complement inhibiting analogthereof. In some embodiments of the invention the composition furthercomprises a moiety that binds to a component present in the eye of asubject at risk of or suffering from an eye disorder characterized bymacular degeneration, choroidal neovascularization, retinalneovascularization, or any combination of these. In certain embodimentsof the invention either of the foregoing compositions further comprisesan angiogenesis inhibitor.

The invention further provides a supramolecular complex comprisingcompstatin or a complement inhibiting analog thereof or comprisingcompstatin and one or more complement inhibiting analogs thereof, orcomprising multiple different complement inhibiting analogs ofcompstatin. In some embodiments the composition contains a plurality ofcompstatin molecules (and/or compstatin analog molecules) attached to apolymeric backbone or scaffold or a multimer of compstatin molecules(and/or compstatin analogs). In some embodiments the composition furthercomprises a soluble gel-forming material.

The invention further provides methods of treating an eye disordercharacterized by macular degeneration, choroidal neovascularization,retinal neovascularization, ocular inflammation, or any combination ofthese, comprising administering any of the compositions of the inventionto a subject at risk of or suffering from the eye disorder. Thecompositions can be administered as sole therapy, or one or more othertreatments for the disorder may also be administered either concurrentlyor sequentially. Such treatments include, but are not limited to, laserphotocoagulation, photodynamic therapy (e.g., Visudyne®), oranti-angiogenic therapy.

Methods for testing the compositions and methods of the invention arealso provided.

Methods for making the compositions of the invention are also provided.

In any of the embodiments of the present invention, the eye disorder canbe a macular degeneration related condition, diabetic retinopathy,retinopathy of prematurity, uveitis, keratitis, scleritis, retinitispigmentosa, or any condition featuring choroidal and/or retinalneovascularization and/or ocular inflammation. In certain embodimentsthe eye disorder is a macular degeneration related condition, e.g.,ARMD. In certain embodiments the eye disorder is diabetic retinopathy.

Included among the eye disorders that can be treated with thecompositions and methods of the invention are eye disorders in whichretinal angiomatous proliferation (RAP) is present. RAP involvesabnormal proliferation of retinal blood vessels (retinalneovascularization) and is a feature of a subtype of neovascular ARMD,but the compositions and methods of the invention can be used to treatRAP due to any cause, whether or not associated with maculardegeneration. The invention therefore provides a method of inhibiting aneye disorder characterized by retinal angiomatous proliferationcomprising (i) providing a subject in need of treatment for the eyedisorder; and (ii) administering a composition comprising compstatin ora complement inhibiting analog thereof, to the subject. The compositioncan be administered using any of the methods described herein. In someembodiments the composition is delivered intravitreally or in closeproximity to the posterior segment of the eye.

In any of the embodiments of the invention that features an angiogenesisinhibitor, the angiogenesis inhibitor may be any angiogenesis inhibitorknown in the art. For example, the angiogenesis inhibitor may, but neednot be, selected from the group consisting of: Macugen® or another VEGFnucleic acid ligand; Lucentis®, Avastin®, or another anti-VEGF antibody;combretastatin or a derivative or prodrug thereof such as CombretastatinA4 Prodrug (CA4P); VEGF-Trap; EVIZON™ (squalamine lactate); AG-013958(Pfizer, Inc.); JSM6427 (Jerini A G), β2-glycoprotein 1 (β2-GP1), and ashort interfering RNA (siRNA) that inhibits expression of one or moreVEGF isoforms (e.g., VEGF₁₆₅) or inhibits expression of a VEGF receptor(e.g., VEGFR1).

Unless otherwise stated, the invention makes use of standard methods ofmolecular biology, chemistry, cell culture, animal maintenance,ophthalmologic examination, and administration of therapeutic agents tosubjects, etc., and uses art-accepted meanings of terms. Thisapplication refers to various patents and publications. The contents ofall scientific articles, books, patents, and other publications,mentioned in this application are incorporated herein by reference. Inaddition, the following publications are incorporated herein byreference: Current Protocols in Molecular Biology, Current Protocols inImmunology, Current Protocols in Protein Science, and Current Protocolsin Cell Biology, all John Wiley & Sons, N.Y., edition as of July 2002;Sambrook, Russell, and Sambrook, Molecular Cloning: A Laboratory Manual,3^(rd) ed., Cold Spring Harbor Laboratory Press, Cold Spring Harbor,2001; Kuby Immunology, 4^(th) ed., Goldsby, R. A., Kindt, T. J., andOsborne, B. (eds.), W.H. Freeman, 2000, Goodman and Gilman's ThePharmacological Basis of Therapeutics, 10^(th) Ed. McGraw Hill, 2001,Katzung, B. (ed.) Basic and Clinical Pharmacology, McGraw-Hill/Appleton& Lange; 9th edition (December 2003), Ophthalmic Surgery: Principles andPractice, 3^(rd) ed., W.B. Saunders Company, 2002; Albert, D M andLucarelli, M J (eds.), Clinical Atlas of Procedures in OphthalmicSurgery, American Medical Association, 2003. It will be appreciated thatthe state of the art may have progressed beyond that represented incertain of the references incorporated herein. In the event of aconflict or inconsistency between any of the incorporated references andthe instant specification, the specification shall typically controlunless modified by amendment, it being understood that the determinationof whether a conflict or inconsistency exists is within the discretionof the inventors and can be made at any time. Art-accepted abbreviationsfor the standard amino acids are used herein.

BRIEF DESCRIPTION OF THE DRAWING

FIGS. 1A-1E show schematic representations of the anterior and posteriorsegments of the eye (1A and 1B) and the outer layers of the eye (1C-1E).FIG. 1C depicts a normal eye. FIG. 1D depicts an eye suffering from dryARMD. FIG. 1E depicts an eye suffering from exudative ARMD. ONL=outernuclear layer; IS=inner segment; OS=outer segment; RPE=retinal pigmentepithelial layer; BM=Bruch's membrane; CC=choriocapillaris. Adapted fromTezel, T., et al., Trends in Molecular Medicine, 10(9), 417-420, 2004.

FIG. 2 shows a schematic diagram of compstatin and of a compstatinanalog (SEQ ID NO: 14) that has increased complement inhibiting activityrelative to compstatin. The figure also shows the IC50 of compstatin andthe compstatin analog for inhibition of human complement. Amino acids 4and 9 in the peptide chain depicted in the upper portion of the figureare as shown on the lower left for compstatin and as shown on the lowerright for the compstatin analog. Thus the boxes labeled “X4” and “X9” inthe peptide chain represent the side chains of the amino acids X4 and X9shown in the lower portion of the figure for compstatin (left) and thecompstatin analog (right) respectively.

FIG. 3 shows a schematic diagram of a compstatin analog (compstatin C;SEQ ID NO: 28) with a higher inhibitory complement inhibiting activitythan compstatin. (Katragadda, et al., 49(15) pp 4616-4622, 2006).

FIG. 4 is a graph showing a comparison of the mean CNV area (in μm²) inmice that received either no treatment or received an intravitrealinjection of albumin, an intravitreal injection of vaccinia complementcontrol protein (VCP) (either 10 or 30 μg), or an intravitreal injectionof a compstatin analog (30 μg).

DEFINITIONS

“Angiogenesis” or “angiogenic” refer to formation, growth, and/ordevelopment of new blood vessels.

The terms “angiogenesis inhibitor” and “antiangiogenic agent” are usedinterchangeably herein to refer to agents that are capable of inhibitingor reducing one or more processes associated with angiogenesisincluding, but not limited to, endothelial cell proliferation,endothelial cell migration, and capillary tube formation. In addition,such agents may inhibit fluid exudation from blood vessels.

The terms “approximately” or “about” in reference to a number generallyinclude numbers that fall within a range of 5% in either direction(greater than or less than) of the number unless otherwise stated orotherwise evident from the context (except where such number wouldimpermissibly exceed 100% of a possible value).

“Biocompatible” refers to a material that is substantially non-toxic tocells in vitro, e.g., if its addition to cells in culture results inless than or equal to 20% cell death. A material is consideredbiocompatible with respect to a recipient if it is substantiallynontoxic to the recipient's cells in the quantities and at the locationused, and also does not elicit or cause a significant deleterious oruntoward effect on the recipient's body, e.g., an immunological orinflammatory reaction, unacceptable scar tissue formation, etc.

“Biodegradable” means that a material is capable of being broken downphysically and/or chemically within cells or within the body of asubject, e.g., by hydrolysis under physiological conditions, by naturalbiological processes such as the action of enzymes present within cellsor within the body, etc., to form smaller chemical species which can bemetabolized and, optionally, reused, and/or excreted or otherwisedisposed of Preferably a biodegradable compound is biocompatible.

A “biological macromolecule” is a large molecule composed of smallersubunits of a type that are found in biological systems. Examples ofbiological macromolecules include polypeptides, nucleic acids, andpolysaccharides. Typically a biological macromolecule contains at least3 subunits (e.g., amino acids, nucleosides, monosaccharides, etc.). Thebiological macromolecule may, but need not be, a naturally occurringpolypeptide, nucleic acid, or polysaccharide. The biologicalmacromolecule may be modified, e.g., it may be conjugated to anonbiological molecule such as synthetic polymer, etc.

“Choroidal neovascularization” (CNV) refers to the abnormal development,proliferation, and/or growth of blood vessels arising from thechoriocapillaris. The blood vessels typically extend through Bruch'smembrane, RPE layer, and/or subretinal space.

A “complement component” or “complement protein” is a molecule that isinvolved in activation of the complement system or participates in oneor more complement-mediated activities. Components of the classicalcomplement pathway include, e.g., C1q, C1r, C1s, C2, C3, C4, C5, C6, C7,C8, C9, and the C5b-9 complex, also referred to as the membrane attackcomplex (MAC) and active fragments or enzymatic cleavage products of anyof the foregoing (e.g., C3a, C3b, C4a, C4b, C5a, etc.). Components ofthe alternative pathway include, e.g., factors B, D, H, and I, andproperdin.

“Concurrent administration” as used herein with respect to two or moreagents, e.g., therapeutic agents, is administration performed usingdoses and time intervals such that the administered agents are presenttogether within the body, or at a site of action in the body such aswithin the eye) over a time interval in not less than de minimisquantities. The time interval can be minutes (e.g., at least 1 minute,1-30 minutes, 30-60 minutes), hours (e.g., at least 1 hour, 1-2 hours,2-6 hours, 6-12 hours, 12-24 hours), days (e.g., at least 1 day, 1-2days, 2-4 days, 4-7 days, etc.), weeks (e.g., at least 1, 2, or 3 weeks,etc. Accordingly, the agents may, but need not be, administered togetheras part of a single composition. In addition, the agents may, but neednot be, administered simultaneously (e.g., within less than 5 minutes,or within less than 1 minute) or within a short time of one another(e.g., less than 1 hour, less than 30 minutes, less than 10 minutes,approximately 5 minutes apart). According to various embodiments of theinvention agents administered within such time intervals may beconsidered to be administered at substantially the same time. In certainembodiments of the invention concurrently administered agents arepresent at effective concentrations within the body (e.g., in the bloodand/or at a site of action such as the retina) over the time interval.When administered concurrently, the effective concentration of each ofthe agents needed to elicit a particular biological response may be lessthan the effective concentration of each agent when administered alone,thereby allowing a reduction in the dose of one or more of the agentsrelative to the dose that would be needed if the agent was administeredas a single agent. The effects of multiple agents may, but need not be,additive or synergistic. The agents may be administered multiple times.The de minimis concentration of an agent may be, for example, less thanapproximately 5% of the concentration that would be required to elicit aparticular biological response, e.g., a desired biological response.

An “effective amount” of an active agent refers to the amount of theactive agent sufficient to elicit a desired biological response. As willbe appreciated by those of ordinary skill in this art, the absoluteamount of a particular agent that is effective may vary depending onsuch factors as the desired biological endpoint, the agent to bedelivered, the target tissue, etc. Those of ordinary skill in the artwill further understand that an “effective amount” may be administeredin a single dose, or may be achieved by administration of multipledoses. For example, an effective amount may be an amount sufficient toachieve one or more of the following: (i) inhibit or prevent drusenformation; (ii) cause a reduction in drusen number and/or size (drusenregression); (iii) cause a reduction in or prevent lipofuscin deposits;(iv) inhibit or prevent visual loss or slow the rate of visual loss; (v)inhibit choroidal neovascularization or slow the rate of choroidalneovascularization; (vi) cause a reduction in size and/or number oflesions characterized by choroidal neovascularization; (vii) inhibitchoroidal neovascularization or slow the rate of retinalneovascularization; (viii) cause a reduction in size and/or number oflesions characterized by retinal neovascularization; (ix) improve visualacuity and/or contrast sensitivity; (x) inhibit or prevent photoreceptoror RPE cell atrophy or apoptosis, or reduce the rate of photoreceptor orRPE cell atrophy or apoptosis; (xi) inhibit or prevent progression ofnon-exudative macular degeneration to exudative macular degeneration;(xii) reduce one or more indicia of inflammation, e.g., the presence ofinflammation-associated cells such as white blood cells (e.g.,neutrophils, macrophages) in the eye, the presence of endogenousinflammatory mediators known in the art, one or more symptoms such aseye pain, redness, light sensitivity, blurred vision and floaters, etc.

An “expression control sequence” refers to a nucleotide sequence in apolynucleotide that regulates the expression (transcription and/ortranslation) of a nucleotide sequence operatively linked thereto.

“Exudative” macular degeneration is used herein synonymously with “wet”type macular degeneration, as those terms are generally understood inthe art, i.e., to refer to a macular degeneration related condition suchas ARMD characterized by neovascularization.

“Fibrillar collagen solids” means the dry collagen solid content offibrillar collagen. Fibrillar collagen is an insoluble collagen materialwherein the collagen molecules interact to form microfibrils whichthemselves aggregate by side-to-side and end-to-end association to formstabilized collagen fibrils.

“Fusion protein” refers to a polypeptide that contains two or moredifferent polypeptides or portions thereof joined together to form asingle polypeptide chain. A recombinant polynucleotide that encodes afusion protein may be created by removing the stop codon from thepolynucleotide that encodes the first polypeptide and appending apolynucleotide that encodes the second polypeptide in frame, so that theresulting recombinant polynucleotide encodes a single polypeptidecomprising the two polypeptides.

“Identity” refers to the extent to which the sequence of two or morenucleic acids or polypeptides is the same. The percent identity betweena sequence of interest and a second sequence over a window ofevaluation, e.g., over the length of the sequence of interest, may becomputed by aligning the sequences, determining the number of residues(nucleotides or amino acids) within the window of evaluation that areopposite an identical residue allowing the introduction of gaps tomaximize identity, dividing by the total number of residues of thesequence of interest or the second sequence (whichever is greater) thatfall within the window, and multiplying by 100. By gap is meant aportion of a sequence that is not occupied by a residue. For example,the sequence A K L - - - SIG (SEQ ID NO: 1) contains a gap of threeresidues. When computing the number of identical residues needed toachieve a particular percent identity, fractions are to be rounded tothe nearest whole number. Percent identity can be calculated with theuse of a variety of computer programs known in the art. For example,computer programs such as BLAST2, BLASTN, BLASTP, Gapped BLAST, etc.,generate alignments and provide percent identity between a sequence ofinterest and sequences in any of a variety of public databases. Thealgorithm of Karlin and Altschul (Karlin and Altschul, Proc. Natl. Acad.Sci. USA 87:22264-2268, 1990) modified as in Karlin and Altschul, Proc.Natl. Acad. Sci. USA 90:5873-5877, 1993 is incorporated into the NBLASTand XBLAST programs of Altschul et al. (Altschul, et al., J. Mol. Biol.215:403-410, 1990). To obtain gapped alignments for comparison purposes,Gapped BLAST is utilized as described in Altschul et al. (Altschul, etal. Nucleic Acids Res. 25: 3389-3402, 1997). When utilizing BLAST andGapped BLAST programs, the default parameters of the respective programsmay be used. A PAM250 or BLOSUM62 matrix may be used. See the Web sitehaving URL www. followed immediately by ncbi.nlm.nih.gov for theseprograms. In a specific embodiment, percent identity of a sequence ofinterest and a second sequence is calculated using BLAST2 with defaultparameters.

The term “isolated” means 1) separated from at least some of thecomponents with which it is usually associated in nature; 2) prepared orpurified by a process that involves the hand of man; and/or 3) notoccurring in nature. For example, a molecule that is removed from a cellthat produces it, is “isolated”. A chemically synthesized molecule is“isolated”.

The term “linked”, when used with respect to two or more moieties, meansthat the moieties are physically associated or connected with oneanother to form a molecular structure that is sufficiently stable sothat the moieties remain associated under the conditions in which thelinkage is formed and, preferably, under the conditions in which the newmolecular structure is used, e.g., physiological conditions. In certainpreferred embodiments of the invention the linkage is a covalentlinkage. In other embodiments the linkage is noncovalent. Moieties maybe linked either directly or indirectly. When two moieties are directlylinked, they are either covalently bonded to one another or are insufficiently close proximity such that intermolecular forces between thetwo moieties maintain their association. When two moieties areindirectly linked, they are each linked either covalently ornoncovalently to a third moiety, which maintains the association betweenthe two moieties. In general, when two moieties are referred to as beinglinked by a “linker” or “linking moiety” or “linking portion”, thelinkage between the two linked moieties is indirect, and typically eachof the linked moieties is covalently bonded to the linker. The linkercan be any suitable moiety that reacts with the two moieties to belinked within a reasonable period of time, under conditions consistentwith stability of the moieties (which may be protected as appropriate,depending upon the conditions), and in sufficient amount, to produce areasonable yield.

“Liposomes” are artificial microscopic spherical particles formed by alipid bilayer (or multilayers) enclosing an aqueous compartment.Liposomes can be used for delivering certain of the compositions of theinvention.

“Local administration” or “local delivery”, in reference to delivery ofa composition or agent of the invention, refers to delivery that doesnot rely upon transport of the composition or agent to its intendedtarget tissue or site via the vascular system. The composition or agentmay be delivered directly to its intended target tissue or site, or inthe vicinity thereof, e.g., in close proximity to the intended targettissue or site. For example, the composition may be delivered byinjection or implantation of the composition or agent or by injection orimplantation of a device containing the composition or agent. Followinglocal administration in the vicinity of a target tissue or site, thecomposition or agent, or one or more components thereof, may diffuse tothe intended target tissue or site. It will be understood that oncehaving been locally delivered a fraction of a therapeutic agent(typically only a minor fraction of the administered dose) may enter thevascular system and be transported to another location, including backto its intended target tissue or site.

“Macular degeneration related condition” refers to any of a number ofdisorders and conditions in which the macula degenerates or losesfunctional activity. The degeneration or loss of functional activity canarise as a result of, for example, cell death, decreased cellproliferation, loss of normal biological function, or a combination ofthe foregoing. Macular degeneration can lead to and/or manifest asalterations in the structural integrity of the cells and/orextracellular matrix of the macula, alteration in normal cellular and/orextracellular matrix architecture, and/or the loss of function ofmacular cells. The cells can be any cell type normally present in ornear the macula including RPE cells, photoreceptors, and/or capillaryendothelial cells. ARMD is the major macular degeneration relatedcondition, but a number of others are known including, but not limitedto, Best macular dystrophy, Sorsby fundus dystrophy, MallatiaLeventinese and Doyne honeycomb retinal dystrophy.

“Marker”, for the purpose of the description of the invention, may referto any molecular moiety (e.g., protein, peptide, mRNA or other RNAspecies, DNA, lipid, carbohydrate) that characterizes, indicates, oridentifies a particular diseased or physiological state (e.g.,apoptotic, cancerous, normal) or characterizes, indicates, or identifiesone or more cell type(s), tissue type(s), or embryological origin. Thepresence or absence of certain marker(s), or the amount of certainmarker(s), may indicate a particular physiological or diseased state ofa patient, organ, tissue, or cell. A cellular marker is a marker foundin or on a cell. A cellular marker may, but need not be, cell typespecific. For example, a cell type specific marker is generally aprotein, peptide, mRNA, lipid, or carbohydrate that is present at ahigher level on or in a particular cell type or cell types of interestthan on or in many other cell types. In some instances a cell typespecific marker is present at detectable levels only on or in aparticular cell type of interest. However, it will be appreciated thatuseful markers need not be absolutely specific for the cell type ofinterest. For example, certain CD molecules are present on the cells ofmultiple different types of leukocytes. In general, a cell type specificmarker for a particular cell type is expressed at levels at least 3 foldgreater in that cell type than in a reference population of cells whichmay consist, for example, of a mixture containing cells from a plurality(e.g., 5-10 or more) of different tissues or organs in approximatelyequal amounts. More preferably the cell type specific marker is presentat levels at least 4-5 fold, between 5-10 fold, or more than 10-foldgreater than its average expression in a reference population.Preferably detection or measurement of a cell type specific marker makesit possible to distinguish the cell type or types of interest from cellsof many, most, or all other types. In general, the presence and/orabundance of most markers may be determined using standard techniquessuch as Northern blotting, in situ hybridization, RT-PCR, sequencing,immunological methods such as immunoblotting, immunodetection, orfluorescence detection following staining with fluorescently labeledantibodies, oligonucleotide or cDNA microarray or membrane array,protein microarray analysis, mass spectrometry, etc.

“Non-exudative” macular degeneration is used herein synonymously with“dry” type macular degeneration as those terms are generally used in theart, to refer to a macular degeneration related condition, e.g., ARMD,in which neovascularization that would be detectable using standardmethods such as fluorescein angiography has not occurred.

“Operably linked” or “operably associated” refers to a relationshipbetween two nucleic acid sequences wherein the expression of one of thenucleic acid sequences is controlled by, regulated by, modulated by,etc., the other nucleic acid sequences, or a relationship between twopolypeptides wherein the expression of one of the polypeptides iscontrolled by, regulated by, modulated by, etc., the other polypeptide.For example, the transcription of a nucleic acid sequence is directed byan operably linked promoter sequence; post-transcriptional processing ofa nucleic acid is directed by an operably linked processing sequence;the translation of a nucleic acid sequence is directed by an operablylinked translational regulatory sequence; the transport, stability, orlocalization of a nucleic acid or polypeptide is directed by an operablylinked transport or localization sequence; and the post-translationalprocessing of a polypeptide is directed by an operably linked processingsequence. Preferably a nucleic acid sequence that is operably linked toa second nucleic acid sequence, or a polypeptide that is operativelylinked to a second polypeptide, is covalently linked, either directly orindirectly, to such a sequence, although any effective three-dimensionalassociation is acceptable.

“Plurality” means more than one.

“Polynucleotide” or “oligonucleotide” refers to a polymer ofnucleotides. As used herein, an oligonucleotide is typically less than100 nucleotides in length. A polynucleotide or oligonucleotide may alsobe referred to as a nucleic acid. Typically, a polynucleotide comprisesat least three nucleotides. A nucleotide comprises a nitrogenous base, asugar molecule, and a phosphate group. A nucleoside comprises anitrogenous base linked to a sugar molecule. In a polynucleotide oroligonucleotide, phosphate groups covalently link adjacent nucleosidesto form a polymer. The polymer may comprise or natural nucleosides foundin DNA or RNA (e.g., adenosine, thymidine, guanosine, cytidine, uridine,deoxyadenosine, deoxythymidine, deoxyguanosine, and deoxycytidine),other nucleosides or nucleoside analogs, nucleosides containingchemically modified bases and/or biologically modified bases (e.g.,methylated bases), intercalated bases, modified sugars, etc. Thephosphate groups in a polynucleotide or oligonucleotide are typicallyconsidered to form the internucleoside backbone of the polymer. Innaturally occurring nucleic acids (DNA or RNA), the backbone linkage isvia a 3′ to 5′ phosphodiester bond. However, polynucleotides andoligonucletides containing modified backbones or non-naturally occurringinternucleoside linkages can also be used in the present invention. Suchmodified backbones include ones that have a phosphorus atom in thebackbone and others that do not have a phosphorus atom in the backbone.Examples of modified linkages include, but are not limited to,phosphorothioate and 5′-N-phosphoramidite linkages. See Kornberg andBaker, DNA Replication, 2nd Ed. (Freeman, San Francisco, 1992), Scheit,Nucleotide Analogs (John Wiley, New York, 1980), U.S. Patent Pub. No.20040092470 and references therein for further discussion of variousnucleotides, nucleosides, and backbone structures that can be used inthe polynucleotides or oligonucleotides described herein, and methodsfor producing them. Typically a polynucleotide of this invention is DNAor RNA.

Polynucleotides and oligonucleotides need not be uniformly modifiedalong the entire length of the molecule. For example, differentnucleotide modifications, different backbone structures, etc., may existat various positions in the polynucleotide or oligonucleotide. Any ofthe polynucleotides described herein may utilize these modifications.

The polynucleotide may be of any size or sequence and may be single- ordouble-stranded. If single-stranded the polynucleotide may be the coding(sense) strand or non-coding (anti-sense) strand.

The polynucleotide may be provided by any means known in the art. Incertain embodiments, the polynucleotide has been engineered usingrecombinant techniques (for a more detailed description of thesetechniques, please see Ausubel et al. Current Protocols in MolecularBiology (John Wiley & Sons, Inc., New York, 1999); Molecular Cloning: ALaboratory Manual, 2nd Ed., ed. by Sambrook, Fritsch, and Maniatis (ColdSpring Harbor Laboratory Press: 1989). The polynucleotide may also beobtained from natural sources and purified from contaminating componentsfound normally in nature. The polynucleotide may be synthesized usingenzymatic techniques, either within cells or in vitro. Thepolynucleotide may also be chemically synthesized in a laboratory, e.g.,using standard solid phase chemistry. The polynucleotide may be modifiedby chemical and/or biological means. In certain preferred embodiments,these modifications lead to increased stability of the polynucleotide.Modifications include methylation, phosphorylation, end-capping, etc.

The term “polynucleotide sequence” or “nucleic acid sequence” as usedherein can refer to the nucleic acid material itself and is notrestricted to the sequence information (i.e. the succession of letterschosen among the five base letters A, G, C, T, or U) that biochemicallycharacterizes a specific nucleic acid, e.g., a DNA or RNA molecule. Anucleic acid sequence is presented in the 5′ to 3′ direction unlessotherwise indicated.

“Polypeptide”, as used herein, refers to a polymer of amino acids,optionally including one or more amino acid analogs. A protein is amolecule composed of one or more polypeptides. A peptide is a relativelyshort polypeptide, typically between about 2 and 60 amino acids inlength. The terms “protein”, “polypeptide”, and “peptide” may be usedinterchangeably. Polypeptides used herein may contain amino acids suchas those that are naturally found in proteins, amino acids that are notnaturally found in proteins, and/or amino acid analogs that are notamino acids. As used herein, an “analog” of an amino acid may be adifferent amino acid that structurally resembles the amino acid or acompound other than an amino acid that structurally resembles the aminoacid. A large number of art-recognized analogs of the 20 amino acidscommonly found in proteins (the “standard” amino acids) are known. Oneor more of the amino acids in a polypeptide may be modified, forexample, by the addition of a chemical entity such as a carbohydrategroup, a phosphate group, a farnesyl group, an isofarnesyl group, afatty acid group, a linker for conjugation, functionalization, or othermodification, etc. Certain non-limiting suitable analogs andmodifications are described in WO2004026328. The polypeptide may beacetylated, e.g., at the N-terminus and/or amidated, e.g., at theC-terminus.

The natural or other chemical modifications such as those describedabove can occur anywhere in a polypeptide, including the peptidebackbone, the amino acid side-chains and the amino or carboxyl termini.A given polypeptide may contain many types of modifications.Polypeptides may be branched, for example, as a result ofubiquitination, and they may be cyclic, with or without branching.Polypeptides may be conjugated with, encapsulated by, or embedded withina polymer or polymeric matrix, dendrimer, nanoparticle, microparticle,liposome, or the like.

Polypeptides may, for example, be purified from natural sources,produced in vitro or in vivo in suitable expression systems usingrecombinant DNA technology in suitable expression systems (e.g., byrecombinant host cells or in transgenic animals or plants), synthesizedthrough chemical means such as conventional solid phase peptidesynthesis and/or methods involving chemical ligation of synthesizedpeptides (see, e.g., Kent, S., J Pept Sci., 9(9):574-93, 2003), or anycombination of the foregoing. These methods are well known, and one ofskill in the art will be able to select and implement an appropriatemethod for synthesizing the peptides and polypeptides described herein.A polypeptide may comprise one or more chemical ligation sites asdescribed, for example, in U.S. Pub. No. 20040115774. In certainembodiments a polypeptide of the invention is modified with a polymerusing one or more of the methods described or referenced therein.

The term “polypeptide sequence” or “amino acid sequence” as used hereincan refer to the polypeptide material itself and is not restricted tothe sequence information (i.e. the succession of letters or three lettercodes chosen among the letters and codes used as abbreviations for aminoacid names) that biochemically characterizes a polypeptide. Apolypeptide sequence presented herein is presented in an N-terminal toC-terminal direction unless otherwise indicated.

“Posterior segment of the eye” refers to the portion of the eye behindthe lens, including the vitreous, choroid, and retina (including themacula).

“Purified”, as used herein, means that an entity or substance isseparated from one or more other entities or substances with which itwas previously found before being purified. An entity or substance maybe partially purified, substantially purified, or pure. A substance orentity such as a nucleic acid or polypeptide is considered pure when itis removed from substantially all other compounds or entities other thana solvent and any ions contained in the solvent, i.e., it constitutes atleast about 90%, more preferably at least about 91%, 92%, 93%, 94%, 95%,96%, 97%, 98%, 99%, or greater than 99% of the dry weight of thecomposition. A partially or substantially purified compound or entitysuch as a nucleic acid or polypeptide may be removed from at least 50%,at least 60%, at least 70%, or at least 80% by weight of the materialwith which it is naturally found, e.g., cellular material such ascellular proteins and/or nucleic acids. In certain embodiments the of apurified nucleic acid or polypeptide constitutes at least 10%, 20%, 30%,40%, 50%, 60%, 70%, 80%, 90%, 95%, 99% or even more, by dry weight, ofthe total nucleic acid or polypeptide, respectively, in a composition.Methods for assessing purity are known in the art and includechromatographic methods, immunological methods, electrophoretic methods,etc. Any of the polynucleotides or polypeptides described herein may bepurified.

“Reactive functional groups” as used herein refers to groups including,but not limited to, olefins, acetylenes, alcohols, phenols, ethers,oxides, halides, aldehydes, ketones, carboxylic acids, esters, amides,cyanates, isocyanates, thiocyanates, isothiocyanates, amines,hydrazines, hydrazones, hydrazides, diazo, diazonium, nitro, nitriles,mercaptans, sulfides, disulfides, sulfoxides, sulfones, sulfonic acids,sulfinic acids, acetals, ketals, anhydrides, sulfates, sulfenic acidsisonitriles, amidines, imides, imidates, nitrones, hydroxylamines,oximes, hydroxamic acids thiohydroxamic acids, allenes, ortho esters,sulfites, enamines, ynamines, ureas, pseudoureas, semicarbazides,carbodiimides, carbamates, imines, azides, azo compounds, azoxycompounds, and nitroso compounds. Reactive functional groups alsoinclude those frequently used to prepare bioconjugates, e.g.,N-hydroxysuccinimide esters, maleimides, sulfhydryls, and the like (see,for example, Hermanson, G., Bioconjugate Techniques, Academic press, SanDiego, 1996). Methods to prepare each of these functional groups arewell known in the art and their application to or modification for aparticular purpose is within the ability of one of skill in the art(see, for example, Sandler and Karo, eds. ORGANIC FUNCTIONAL GROUPPREPARATIONS, Academic Press, San Diego, 1989).

“Recombinant host cells”, “host cells”, and other such terms, denoteprokaryotic or eukaryotic cells or cell lines that have been used asrecipients for an exogenous nucleic acid (typically DNA) such as anexpression vector into which a nucleic acid portion that encodes apolypeptide of interest has been inserted. These terms include theprogeny of the original cell into which the vector or other nucleic acidhas been introduced. Appropriate unicellular host cells include any ofthose routinely used in expressing polynucleotides (e.g., eukaryotic,mammalian, and/or viral polynucleotides) including, for example,prokaryotes, such as E. coli; and eukaryotes, including for example,fungi, such as yeast (e.g., Pichia pastoris); insect cells (e.g., Sf9),plant cells, and animal cells, e.g., mammalian cells such as CHO, R1.1,B-W, L-M, African Green Monkey Kidney cells (e.g. COS-1, COS-7, BSC-1,BSC-40 and BMT-10) and cultured human cells. Terms such as “host cells”,etc., are also used to refer to cells or cell lines that can be used asrecipients for an exogenous nucleic acid, prior to its introduction. A“recombinant polynucleotide” is one that contains nucleic acid portionsthat are not found joined together in nature. A “recombinantpolypeptide” is a polypeptide that is produced by transcription andtranslation of an exogenous nucleic acid by a recombinant host cell,typically after introduction of an expression vector that contains aportion that encodes the recombinant polypeptide into the host cell.

“Retinal neovascularization” refers to the abnormal development,proliferation, and/or growth of blood vessels on or in the retina, e.g.,on the retinal surface.

“Sequential administration” of two or more agents refers toadministration of two or more agents to a subject such that the agentsare not present together in the subject's body, or at a relevant site ofactivity in the body, at greater than de minimis concentrations.Administration of the agents may, but need not, alternate. Each agentmay be administered multiple times.

“Specific binding” generally refers to a physical association between atarget polypeptide (or, more generally, a target molecule) and a bindingmolecule such as an antibody or ligand. The association is typicallydependent upon the presence of a particular structural feature of thetarget such as an antigenic determinant, epitope, binding pocket orcleft, recognized by the binding molecule. For example, if an antibodyis specific for epitope A, the presence of a polypeptide containingepitope A or the presence of free unlabeled A in a reaction containingboth free labeled A and the binding molecule that binds thereto, willreduce the amount of labeled A that binds to the binding molecule. It isto be understood that specificity need not be absolute but generallyrefers to the context in which the binding occurs. For example, it iswell known in the art that numerous antibodies cross-react with otherepitopes in addition to those present in the target molecule. Suchcross-reactivity may be acceptable depending upon the application forwhich the antibody is to be used. One of ordinary skill in the art willbe able to select antibodies or ligands having a sufficient degree ofspecificity to perform appropriately in any given application (e.g., fordetection of a target molecule, for therapeutic purposes, etc). It isalso to be understood that specificity may be evaluated in the contextof additional factors such as the affinity of the binding molecule forthe target versus the affinity of the binding molecule for othertargets, e.g., competitors. If a binding molecule exhibits a highaffinity for a target molecule that it is desired to detect and lowaffinity for nontarget molecules, the antibody will likely be anacceptable reagent. Once the specificity of a binding molecule isestablished in one or more contexts, it may be employed in other,preferably similar, contexts without necessarily re-evaluating itsspecificity. Binding of two or more molecules may be considered specificif the affinity (as measured by the equilibrium dissociation constant,Kd) is 10⁻³ M or less, preferably 10⁻⁴M or less, more preferably 10⁻⁵ Mor less, e.g., 10⁻⁶M or less, 10⁻⁷M or less, 10⁻⁸M or less, or 10⁻⁹M orless under the conditions tested, e.g., under physiological conditions.

“Significant sequence homology” as applied to an amino acid sequencemeans that the sequence displays at least approximately 20% identical orconservatively replaced amino acids, preferably at least approximately30%, at least approximately 40%, at least approximately 50%, at leastapproximately 60% identical or conservatively replaced amino acids,desirably at least approximately 70% identical or conservativelyreplaced amino acids, more desirably at least approximately 80%identical or conservatively replaced amino acids, and most desirably atleast approximately 90% amino acid identical or conservatively replacedamino acids relative to a reference sequence. When two or more sequencesare compared, any of them may be considered the reference sequence.Percent identity can be calculated using a FASTA or BLASTP algorithm,using default parameters. A PAM250 or BLOSUM62 matrix may be used. Forpurposes of calculating % identical or conservatively replaced residues,a conservatively replaced residue is considered identical to the residueit replaces. Conservative replacements may be defined in accordance withStryer, L. Biochemistry, 3rd ed., 1988, according to which amino acidsin the following groups possess similar features with respect to sidechain properties such as charge, hydrophobicity, aromaticity, etc. (1)Aliphatic side chains: G, A, V, L, I; (2) Aromatic side chains: F, Y, W;(3) Sulfur-containing side chains: C, M; (4) Aliphatic hydroxyl sidechains: S, T; (5) Basic side chains: K, R, H; (6) Acidic amino acids: D,E, N, Q; (7) Cyclic aliphatic side chain: P, which may be considered tofall within group (1).

“Subject”, as used herein, refers to an individual to whom an agent isto be delivered, e.g., for experimental, diagnostic, and/or therapeuticpurposes. Preferred subjects are mammals, particularly domesticatedmammals (e.g., dogs, cats, etc.), non-human primates, or humans.

“Supramolecular complex” refers to an assembly comprising at least twoentities that are physically associated with one another, in which oneor more entities is not covalently linked to another entity but isinstead associated with that entity by through one or more noncovalentinteractions mechanisms such as ionic interactions, hydrogen bonds,hydrophobic interactions, π-stacking, dative bonds, etc. For example,one or more entities may be entrapped, embedded, enclosed, orencapsulated within another entity, or entangled with another entity, ordissolved in another entity, or impregnated with another entity, oradsorbed to another entity, or bound to another entity, so as tomaintain a physical association between the entities. The entities maybe naturally occurring or synthetic. They may be, for example,polypeptides, non-polypeptide polymers, nucleic acids, lipids, smallmolecules, carbohydrates, etc. One or more of the entities may be arigid or flexible polymer scaffold, a three-dimensional structure suchas a microparticle, nanoparticle, liposome, dendrimer, etc. Thesupramolecular complex can contain any number or combination ofmolecules and/or other entities.

“Treating”, as used herein, refers to providing treatment, i.e,providing any type of medical or surgical management of a subject. Thetreatment can be provided in order to reverse, alleviate, inhibit theprogression of, prevent or reduce the likelihood of a disease, disorder,or condition, or in order to reverse, alleviate, inhibit or prevent theprogression of, prevent or reduce the likelihood of one or more symptomsor manifestations of a disease, disorder or condition. “Prevent” refersto causing a disease, disorder, condition, or symptom or manifestationof such not to occur for at least a period of time in at least someindividuals. Treating can include administering an agent to the subjectfollowing the development of one or more symptoms or manifestationsindicative of a condition such as macular degeneration or diabeticretinopathy, e.g., in order to reverse, alleviate, reduce the severityof, and/or inhibit or prevent the progression of the condition and/or toreverse, alleviate, reduce the severity of, and/or inhibit or one ormore symptoms or manifestations of the condition. A composition of thisinvention can be administered to a subject who has developed an eyedisorder such as exudative or non-exudative ARMD or diabetic retinopathyor is at increased risk of developing such a disorder relative to amember of the general population. A composition of this invention can beadministered prophylactically, i.e., before development of any symptomor manifestation of the condition. Typically in this case the subjectwill be at risk of developing the condition.

“Vector” is used herein to refer to a nucleic acid or a virus or portionthereof (e.g., a viral capsid) capable of mediating entry of, e.g.,transferring, transporting, etc., a nucleic acid molecule into a cell.Where the vector is a nucleic acid, the nucleic acid molecule to betransferred is generally linked to, e.g., inserted into, the vectornucleic acid molecule. A nucleic acid vector may include sequences thatdirect autonomous replication (e.g., an origin of replication), or mayinclude sequences sufficient to allow integration of part or all of thenucleic acid into host cell DNA. Useful nucleic acid vectors include,for example, DNA or RNA plasmids, cosmids, and naturally occurring ormodified viral genomes or portions thereof or nucleic acids (DNA or RNA)that can be packaged into viral capsids. Plasmid vectors typicallyinclude an origin of replication and one or more selectable markers.Plasmids may include part or all of a viral genome (e.g., a viralpromoter, enhancer, processing or packaging signals, etc.). Viruses orportions thereof (e.g., viral capsids) that can be used to introducenucleic acid molecules into cells are referred to as viral vectors.Useful viral vectors include adenoviruses, retroviruses, lentiviruses,vaccinia virus and other poxviruses, herpes simplex virus, and others.Viral vectors may or may not contain sufficient viral geneticinformation for production of infectious virus when introduced into hostcells, i.e., viral vectors may be replication-defective, and suchreplication-defective viral vectors may be preferable for therapeuticuse. Where sufficient information is lacking it may, but need not be,supplied by a host cell or by another vector introduced into the cell.The nucleic acid to be transferred may be incorporated into a naturallyoccurring or modified viral genome or a portion thereof or may bepresent within the virus or viral capsid as a separate nucleic acidmolecule. It will be appreciated that certain plasmid vectors thatinclude part or all of a viral genome, typically including viral geneticinformation sufficient to direct transcription of a nucleic acid thatcan be packaged into a viral capsid and/or sufficient to give rise to anucleic acid that can be integrated into the host cell genome and/or togive rise to infectious virus, are also sometimes referred to in the artas viral vectors. Where sufficient information is lacking it may, butneed not be, supplied by a host cell or by another vector introducedinto the cell.

Expression vectors are vectors that include regulatory sequence(s),e.g., expression control sequences such as a promoter, sufficient todirect transcription of an operably linked nucleic acid. An expressionvector comprises sufficient cis-acting elements for expression; otherelements for expression can be supplied by the host cell or in vitroexpression system. Such vectors typically include one or moreappropriately positioned sites for restriction enzymes, to facilitateintroduction of the nucleic acid to be expressed into the vector.

A “variant” of a particular polypeptide or polynucleotide has one ormore alterations (e.g., additions, substitutions, and/or deletions,which may be referred to collectively as “mutations”) with respect tothe polypeptide or nucleic acid, which may be referred to as the“original polypeptide or polynucleotide”. Thus a variant can be shorteror longer than the polypeptide or polynucleotide of which it is avariant. The terms “variant” encompasses “fragments”. A “fragment” is acontinuous portion of a polypeptide that is shorter than the originalpolypeptide. In certain embodiments of the invention a variantpolypeptide has significant sequence homology to the originalpolypeptide over a continuous portion of the variant that comprises atleast 50%, preferably at least 60%, at least 70%, at least 80%, at least90%, at least 95%, or more, of the length of the variant or the lengthof the polypeptide, (whichever is shorter). In certain embodiments ofthe invention a variant polypeptide has substantial sequence homology tothe original polypeptide over a continuous portion of the variant thatcomprises at least 50%, preferably at least 60%, at least 70%, at least80%, at least 90%, at least 95%, or more, of the length of the variantor the length of the polypeptide, (whichever is shorter). In anon-limiting embodiment a variant has at least 80% identity to theoriginal sequence over a continuous portion of the variant thatcomprises between 90% and 100% of the variant, e.g., over 100% of thelength of the variant or the length of the polypeptide, (whichever isshorter). In another non-limiting embodiment a variant has at least 80%identity to the original sequence over a continuous portion of thevariant that comprises between 90% and 100% of the variant, e.g., over100% of the length of the variant or the length of the polypeptide,(whichever is shorter). In specific embodiments the sequence of avariant polypeptide has N amino acid differences with respect to anoriginal sequence, wherein N is any integer between 1 and 10. In otherspecific embodiments the sequence of a variant polypeptide has N aminoacid differences with respect to an original sequence, wherein N is anyinteger between 1 and 20. An amino acid “difference” refers to asubstitution, insertion, or deletion of an amino acid.

In certain embodiments of the invention a fragment or variant possessessufficient structural similarity to the original polypeptide so thatwhen its 3-dimensional structure (either actual or predicted structure)is superimposed on the structure of the original polypeptide, the volumeof overlap is at least 70%, preferably at least 80%, more preferably atleast 90% of the total volume of the structure of the originalpolypeptide. A partial or complete 3-dimensional structure of thefragment or variant may be determined by crystallizing the protein,which can be done using standard methods. Alternately, an NMR solutionstructure can be generated, also using standard methods. A modelingprogram such as MODELER (Sali, A. and Blundell, T L, J. Mol. Biol., 234,779-815, 1993), or any other modeling program, can be used to generate apredicted structure. If a structure or predicted structure of a relatedpolypeptide is available, the model can be based on that structure. ThePROSPECT-PSPP suite of programs can be used (Guo, J T, et al., NucleicAcids Res. 32(Web Server issue):W522-5, Jul. 1, 2004).

Preferably one, more than one, or all biological functions or activitiesof a variant or fragment is substantially similar to that of thecorresponding biological function or activity of the original molecule.For example, an activity of a variant or fragment is consideredsubstantially similar to the activity of the original molecule if theactivity of the variant or fragment is at least 20%, at least 50%, atleast 60%, at least 70%, at least 80%, or at least 90% of the activityof the original molecule, up to approximately 100%, approximately 125%,or approximately 150% of the activity of the original molecule. In othernonlimiting embodiments an activity of a variant or fragment isconsidered substantially similar to the activity of the originalmolecule if the amount or concentration of the variant needed to producean effect is within 0.5 to 5-fold of the amount or concentration of theoriginal molecule needed to produce that effect.

As used herein, “alkyl” refers to a saturated straight, branched, orcyclic hydrocarbon having from about 1 to about 22 carbon atoms (and allcombinations and subcombinations of ranges and specific numbers ofcarbon atoms therein), with from about 1 to about 12, or about 1 toabout 7 carbon atoms being preferred in certain embodiments of theinvention. Alkyl groups include, but are not limited to, methyl, ethyl,n-propyl, isopropyl, n-butyl, isobutyl, t-butyl, n-pentyl, cyclopentyl,isopentyl, neopentyl, n-hexyl, isohexyl, cyclohexyl, cyclooctyl,adamantyl, 3-methylpentyl, 2,2-dimethylbutyl, and 2,3-dimethylbutyl.

As used herein, “halo” refers to F, Cl, Br or I.

As used herein, “aryl” refers to an optionally substituted, mono- orbicyclic aromatic ring system having from about 5 to about 14 carbonatoms (and all combinations and subcombinations of ranges and specificnumbers of carbon atoms therein), with from about 6 to about 10 carbonsbeing preferred. Non-limiting examples include, for example, phenyl andnaphthyl.

As used herein, “aralkyl” refers to alkyl radicals bearing an arylsubstituent and have from about 6 to about 22 carbon atoms (and allcombinations and subcombinations of ranges and specific numbers ofcarbon atoms therein), with from about 6 to about 12 carbon atoms beingpreferred in certain embodiments. Aralkyl groups can be optionallysubstituted. Non-limiting examples include, for example, benzyl,naphthylmethyl, diphenylmethyl, triphenylmethyl, phenylethyl, anddiphenylethyl.

As used herein, the terms “alkoxy” and “alkoxyl” refer to an optionallysubstituted alkyl-O— group wherein alkyl is as previously defined.Exemplary alkoxy and alkoxyl groups include methoxy, ethoxy, n-propoxy,i-propoxy, n-butoxy, and heptoxy.

As used herein, “carboxy” refers to a —C(═O)OH group.

As used herein, “alkoxycarbonyl” refers to a —C(═O)O-alkyl group, wherealkyl is as previously defined.

As used herein, “aroyl” refers to a —C(═O)-aryl group, wherein aryl isas previously defined. Exemplary aroyl groups include benzoyl andnaphthoyl.

Typically, substituted chemical moieties include one or moresubstituents that replace hydrogen. Exemplary substituents include, forexample, halo, alkyl, cycloalkyl, aralkyl, aryl, sulfhydryl, hydroxyl(—OH), alkoxyl, cyano (—CN), carboxyl (—COOH), —C(═O)O-alkyl,aminocarbonyl (—C(═O)NH₂), —N-substituted aminocarbonyl (—C(═O)NHR″),CF₃, CF₂CF₃, and the like. In relation to the aforementionedsubstituents, each moiety R″ can be, independently, any of H, alkyl,cycloalkyl, aryl, or aralkyl, for example.

As used herein, “L-amino acid” refers to any of the naturally occurringlevorotatory alpha-amino acids normally present in proteins or the alkylesters of those alpha-amino acids. The term D-amino acid” refers todextrorotatory alpha-amino acids. Unless specified otherwise, all aminoacids referred to herein are L-amino acids.

As used herein, an “aromatic amino acid” is an amino acid that comprisesat least one aromatic ring, e.g., it comprises an aryl group.

As used herein, an “aromatic amino acid analog” is an amino acid analogthat comprises at least one aromatic ring, e.g., it comprises an arylgroup.

DETAILED DESCRIPTION OF CERTAIN EMBODIMENTS OF THE INVENTION Overview

The present invention provides compositions and methods for treatment ofeye disorders characterized by macular degeneration, choroidalneovascularization, retinal neovascularization, ocular inflammation, orany combination of the foregoing. The phrase “characterized by” isintended to indicate that macular degeneration, CNV, RNV, and/or ocularinflammation is a characteristic (i.e., typical) feature of thedisorder. Macular degeneration, CNV, RNV, and/or ocular inflammation maybe a defining and/or diagnostic feature of the disorder. Exemplarydisorders that are characterized by one or more of these features andcan be treated with the compositions and methods of the inventioninclude, but are not limited to, macular degeneration relatedconditions, diabetic retinopathy, retinopathy of prematurity,proliferative vitreoretinopathy, uveitis, keratitis, and scleritis. Asmentioned above, macular degeneration refers to a variety ofdegenerative conditions characterized by central visual loss due todeterioration of the macula. The most common of these conditions is agerelated macular degeneration (ARMD), which exists in both “dry” and“wet” forms.

Ocular inflammation can affect a large number of eye structuresincluding the conjunctiva, cornea, episclera, sclera, uveal tract,retina, vasculature, optic nerve, and orbit. Uveitis is a general termthat refers to inflammation in the uvea of the eye, e.g., in any of thestructures of the uvea, including the iris, ciliary body or choroid.Specific types of uveitis include iritis, iridocyclitis, cyclitis, parsplanitis and choroiditis. Uveitis can arise from a number of differentcauses and is associated with a number of different diseases, including,but not limited to, rheumatic diseases such as rheumatic diseases (e.g.,ankylosing spondylitis and juvenile rheumatoid arthritis), certaininfectious diseases such as tuberculosis and syphilis, other conditionssuch as sarcoidosis, systemic lupus erythematosus, chemical injury,trauma, surgery, etc. In one embodiment, the type of uveitis is anterioruveitis. In another embodiment the type of uveitis is posterior uveitis.Keratis refers to inflammation of the cornea. Keratitis has a diversearray of causes including bacterial, viral, or fungal infection, trauma,and allergic reaction. Amoebic infection of the cornea, e.g., caused byAcanthamoeba, is a particular problem for contact lens wearers.Scleritis refers to inflammation of the sclera. Uveitis, keratitis, andscleritis, and methods for their diagnosis are well known in the art.Symptoms of the various inflammatory conditions that affect the eye caninclude, but are not limited to, eye pain, redness, light sensitivity,tearing, blurred vision, floaters. Ocular inflammation of various typesis well known to occur in association with a variety of local orsystemic diseases, some of which are noted above. In some instances thecause may remain unknown.

The invention provides a method of treating an eye disordercharacterized by macular degeneration, choroidal neovascularization,retinal neovascularization, proliferative vitreoretinopathy, glaucoma,ocular inflammation, or any combination of these, comprising (i)providing a subject in need of treatment for the eye disorder; and (ii)administering a composition comprising compstatin or a complementinhibiting analog thereof to the subject. The invention further providesa method of inhibiting CNV, RNV, or both in the eye of a subjectsuffering from or at risk of an eye disorder characterized by maculardegeneration, choroidal neovascularization, retinal neovascularization,proliferative vitreoretinopathy, glaucoma, or any combination of these,comprising the step of: administering a composition comprisingcompstatin or a complement inhibiting analog thereof to or in closeproximity to the posterior segment of the subject's eye. The inventionfurther provides a method of inhibiting CNV, RNV, or both in the eye ofa subject suffering from or at risk of an eye disorder characterized byocular inflammation, comprising the step of: administering a compositioncomprising compstatin or a complement inhibiting analog thereof to or inclose proximity to the posterior segment of the subject's eye.

The invention further provides a method of treating an eye disorderassociated with or caused at least in part by complement activation, themethod comprising the step of administering a compstatin analog to asubject suffering from or at risk of the eye disorder. In one embodimentthe disorder is ARMD. In one embodiment the disorder is diabeticretinopathy. In one embodiment the disorder is uveitis. In oneembodiment the disorder is glaucoma. The invention further provides amethod of treating an eye disorder characterized in that a polymorphismin, or in linkage disequilibrium with, a gene that encodes a complementcomponent is associated with an increased risk of the disorder, themethod comprising the step of administering a compstatin analog to asubject suffering from or at risk of the eye disorder. The polymorphismmay be one that results in increased complement activity. The subjectmay be homozygous or heterozygous for the polymorphism or may notexhibit the polymorphism. The subject may have one or more other riskfactors for developing the disorder. The invention further provides amethod of treating an eye disorder characterized in that a polymorphismin, or in linkage disequilibrium with, a gene that encodes a complementcomponent is associated with a decreased risk of the disorder, themethod comprising the step of administering a compstatin analog to asubject suffering from or at risk of the eye disorder. The polymorphismmay be one that results in decreased complement activity. The subjectmay be homozygous or heterozygous for the polymorphism or may notexhibit the polymorphism. The subject may have one or more risk factorsfor developing the disorder. In certain embodiments of the invention thedisorder is ARMD.

The events that occur in ARMD may be understood with reference to thevarious panels of FIG. 1. FIGS. 1A and 1B show structures present in theanterior and posterior segments of the eye, including the retina, whichcontains the macula. FIGS. 1C-1E depict the outer layers of a normal eye(1C), an eye suffering from dry ARMD (1D), and an eye suffering fromexudative (wet) ARMD (1E). The outer nuclear layer (ONL), containsnuclei of rod and cone photoreceptors. Each photoreceptor contains aninner segment (IS) and outer segment (OS), the latter of which containsthe pigment rhodopsin, which initiates the phototransduction cascadefollowing exposure to light. The retinal pigment epithelial layer (RPE)lies below the photoreceptors and above Bruch's membrane, a layer ofextracellular matrix that separates the RPE from a network ofcapillaries, the choriocapillaris (CC).

Dry ARMD is characterized by the existence of deposits known as drusenand the separation of the RPE from BM, which is often accompanied by RPEatrophy and apoptosis and loss of underlying choriocapillaris andoverlying photoreceptors, resulting in some instances in areas ofgeographic atrophy which can eventually coalesce to form large patches.In exudative ARMD, new blood vessels grow from the choriocapillaristhrough Bruch's membrane and can extend into the RPE and photoreceptorcell layers (choroidal neovascularization). These blood vessels canbleed and leak fluid, frequently resulting in sudden visual loss due toevents such as RPE and/or retinal detachment. Eventually a fibrovascularscar may form, leading to irreversible visual loss. In some forms ofneovascular ARMD, angiomatous proliferation originates from the retinaand extends posteriorly into the subretinal space, eventuallycommunicating in some cases with new choroidal vessels. This form ofneovascular ARMD, termed retinal angiomatous proliferation (RAP), can beparticularly severe. It has been suggested that angiomatousproliferation within the retina is the first manifestation of thevasogenic process in this form of neovascular ARMD. Dilated retinalvessels and pre-, intra-, and subretinal hemorrhages and exudate evolve,surrounding the angiomatous proliferation as the process extends intothe deep retina and subretinal space. The present invention providescompositions and methods that inhibit one or more of the events orprocesses that take place in ARMD. The invention is based in part on thediscovery that certain complement inhibitors are particularly suitableas therapeutic agents for macular degeneration and related conditions,for diabetic retinopathy, and/or for choroidal neovascularizationassociated with any of these disorders, or others. As described inExample 1, an analog of the cyclic peptide compstatin was shown to beeffective in significantly inhibiting the development of CNV in ananimal model, i.e., the compstatin analog was effective in preventing atleast some of the CNV that would otherwise have occurred. Example 1 alsopresents data showing that another inhibitor of complement activation,vaccinia virus complement control protein (VCP) also significantlyinhibits the development of CNV in an animal model, i.e., VCP iseffective in preventing at least some of the CNV that would otherwisehave occurred. To the best of the inventors' knowledge, this workrepresents the first demonstration that administration of an inhibitorof complement activation is effective in inhibiting and at leastpartially preventing development of CNV and the first demonstration thatthese agents will be effective treatments for eye disorders such asthose discussed herein.

To facilitate understanding of the invention, the complement system willfirst be briefly outlined. Further information is found in thereferences cited herein. Subsequent sections describe compstatin andanalogs thereof, compositions containing compstatin and/or analog(s)thereof, methods of use, etc.

Complement Pathways

The complement system plays a crucial role in a number of physiologicalprocesses including the response to injury and defense against foreignentities such as infectious agents. The complement system is also knownto play a role in a number of diseases (Makrides, S. C., Pharm Rev.,50(1): 59-87). The complement system comprises more than 30 serum andcellular proteins that are involved in two major pathways, known as theclassical and alternative pathways (Kuby Immunology, 2000).

The classical pathway is usually triggered by binding of a complex ofantigen and IgM or IgG antibody to C1 (though certain other activatorscan also initiate the pathway). Activated C1 cleaves C4 and C2 toproduce C4a and C4b, in addition to C2a and C2b. C4b and C2a combine toform C3 convertase, which cleaves C3 to form C3a and C3b. Binding of C3bto C3 convertase produces C5 convertase, which cleaves C5 into C5a andC5b. C3a, C4a, and C5a are anaphylotoxins and mediate multiple reactionsin the acute inflammatory response. C3a and C5a are also chemotacticfactors that attract immune system cells such as neutrophils. C3 and C5convertase activity is controlled by a number of endogenous members ofthe Regulators of Complement Activation (RCA) family, also calledComplement Control Protein (CCP) family, which includes complementreceptor type 1 (CR1; C3b:C4b receptor), complement receptor type 2(CR2), membrane cofactor protein (MCP; CD46), decay-accelerating factor(DAF), factor H (1H), and C4b-binding protein (C4 bp). Makrides, 1998,and references therein describe the complement system and itscomponents. RCA proteins are also described in U.S. Pat. No. 6,897,290.

The alternative pathway is initiated by microbial surfaces and variouscomplex polysaccharides. In this pathway, C3b, resulting from cleavageof C3, which occurs spontaneously at a low level, binds to targets,e.g., on cell surfaces and forms a complex with factor B, which is latercleaved by factor D, resulting in a C3 convertase. Cleavage of C3 andbinding of another molecule of C3b to the C3 convertase gives rise to aC5 convertase. C3 and C5 convertases of this pathway are regulated byCR1, DAF, MCP, and fH. The mode of action of these proteins involveseither decay accelerating activity (i.e., ability to dissociateconvertases), ability to serve as cofactors in the degradation of C3b orC4b by factor I, or both.

The C5 convertases produced in both pathways cleave C5 to produce C5aand C5b. C5b then binds to C6, C7, and C8 to form C5b-8, which catalyzespolymerization of C9 to form the C5b-9 membrane attack complex (MAC).The MAC inserts itself into target cell membranes and causes cell lysis.Small amounts of MAC on the membrane of cells may have a variety ofconsequences other than cell death.

A third complement pathway, the lectin complement pathway is initiatedby binding of mannose-binding lectin (MBL) and MBL-associated serineprotease (MASP) to carbohydrates. In the human lectin pathway, MASP-1and MASP-2 are involved in the proteolysis of C4, C2 and C3, leading toa C3 convertase described above.

As mentioned above, complement activity is regulated by variousmammalian proteins referred to as complement control proteins (CCPs).These proteins differ with respect to ligand specificity andmechanism(s) of complement inhibition (Lisczewski, M K and Atkinson, JP, in The Human Complement System in Health and Disease, eds. Volanakis,J E and Frank, M M, Dekker, New York, pp. 149-66, 1998). They mayaccelerate the normal decay of convertases and/or function as cofactorsfor factor I, to enzymatically cleave C3b and/or C4b into smallerfragments. CCPs are characterized by the presence of multiple (typically4-56) homologous motifs known as short consensus repeats (SCR),complement control protein (CCP) modules, or SUSHI domains (Reid, K B Mand Day, A J, Immunol Today, 10:177-80, 1989). These domains, consistingof approximately 50-70 amino acids, typically about 60 amino acids, arecharacterized by a conserved motif that includes four disulfide-bondedcysteines (two disulfide bonds), proline, tryptophan, and manyhydrophobic residues.

Compstatin, Compstatin Analogs, and Methods of Use Thereof

Compstatin is a cyclic peptide that binds to complement component C3 andinhibits complement activation. Compstatin inhibits cleavage of C3 toC3a and C3b by convertase. Since C3 is a central component of all threepathways of complement activation, compstatin and analogs thereof areable to inhibit activation of the converging protein of all threepathways. Without wishing to be bound by any theory, the ability ofcompstatin and analogs thereof to inhibit the alternative pathway ofcomplement activation may contribute significantly to efficacy incertain of the ophthalmic conditions described herein.

The inventors propose that delivery of a therapeutic agent in asustained manner over a prolonged period of time (e.g., 3-6 months, 6-12months, 1-2 years) will offer opportunities to inhibit progression ofchronic ophthalmic diseases such as ARMD and allow intervention early inthe disease process before significant vision loss has occurred. Theinvention encompasses the recognition that complement inhibitors, andcompstatin analogs in particular, possess unique and unexpectedadvantages in this and other respects as compared, for example, withexisting or proposed therapeutics such as angiogenesis inhibitors andanti-inflammatory steroids.

The invention further encompasses the recognition that compstatin andanalogs thereof possess unique and unexpected advantages as comparedwith other complement inhibitors. The relatively low molecular weight(˜1.6 kD) and various other properties of compstatin analogs facilitatetheir incorporation into sustained delivery formulations and devicessuitable for providing therapeutic concentrations to ocular tissues. Inaddition, the inventors determined that the half-life of a compstatinanalog (compstatin C) in vitro in the vitreous was high (˜6.9 hours) ascompared with the rate at which compstatin is degraded and/or clearedfrom the bloodstream in vivo (half-life of <15 min). The inventors'calculations establish, for the first time, the feasibility ofsubstantially inhibiting C3 activation at levels at or above thoseexpected to be present in the vitreous of a subject with wet ARMD bysustained intravitreal delivery of amounts as little as 5 μg/day of atherapeutic agent, which amounts may, according to the invention, bedelivered by intravitreal implant technology over prolonged periods oftime (as described further below). The inventors' calculations alsoestablish, for the first time, the feasibility of substantiallyinhibiting C3 activation at levels at or above those expected to bepresent in the vitreous of a subject with dry ARMD by sustainedintravitreal delivery of amounts as low as 2 μg/day of a therapeuticagent, which amounts may be delivered over prolonged periods of time byintravitreal implant technology according to the present invention.

The invention provides a method of inhibiting complement activation inthe eye of a subject comprising administering a compstatin analog to thesubject in an amount effective to detectably inhibit complementactivation in the vitreous, retina, or both, of the subject over aperiod of at least 3 months, e.g., 3-6 months, 6-12 months, 12-24months, 24-36 months, etc. In certain embodiments of the invention thecompstatin analog is administered by one or more intravitrealinjections. In certain embodiments of the invention the compstatinanalog is administered by release from an ocular insert or othersustained release formulation such as microparticles or nanoparticles.The compstatin analog may be released by diffusion out of theformulation or may be released as the formulation erodes. The treatmentmay be repeated multiple times. In certain embodiments theadministration is performed at intervals of, on average, every 6-12months, or every 12-24 months. In certain embodiments the ocular insertor other sustained release formulation is biodegradable. In certainembodiments the subject suffers from an ocular disorder. In certainembodiments the effective concentration is between 10% and 250% of theaverage concentration of C3 in the vitreous of eyes suffering from theocular disorder. In certain embodiments the subject is at risk of anocular disorder. In certain embodiments the subject has one or moregenetic polymorphisms that are associated with increased risk of anocular disorder, e.g., ARMD. The genetic polymorphism may be in a genethat encodes a complement component such as complement factor H(CFH) orB (CFB). The genetic polymorphism may be in LOC387715 or PLEKHAl. In anyof the foregoing embodiments the ocular disorder may be wet or dry ARMD.Exemplary polymorphisms that increase risk of ARMD are located in genesthat encode CFH (e.g., Y402H—see Donoso, L, et al, Survey ofOphthalmology, Vol. 51, No. 2, 137-152, 2006, and references thereinwhich are incorporated herein by reference), toll-like receptor 4 (TLR4)(e.g., D299G—see Zareparsi, et al., Human Molecular Genetics, vol. 14,no. 11, pp. 1449-1455, 2005), or in LOC387715 or PLEKHAl (Donoso,supra). Li, M., et al., Nat. Genet. 38(9):1049-1054, 2006, and Maller,J., et al., Nat. Genet., 38(9):1055-1059, 2006, describe additionalpolymorphisms in coding and noncoding portions of the CFH gene that areassociated with increased risk of ARMD. It will be appreciated that somepolymorphisms are associated with a decreased risk of ARMD. See, e.g.,Hughes, et al., Nat. Genet., 38(10):1173-7, 2006, describing a haplotypewith deletion of CFHR1 and CFHR3 associated with decreased risk of ARMD.These polymorphisms may be protective against ARMD. It will further beappreciated that polymorphisms that are in linkage disequilibrium withany of the afore-mentioned polymorphisms may also be informative forpurposes of determining whether a subject is at increased risk of ARMDand/or for quantitatively determining the risk. In certain embodimentsthe alternative pathway is inhibited. In certain embodiments theclassical pathway is inhibited. In certain embodiments the lectinpathway is inhibited. In certain embodiments at least two of thealternate, classical, and lectin pathways is inhibited.

Compstatin is described in U.S. Pat. No. 6,319,897, which isincorporated herein by reference. As described therein, compstatin hasthe sequence Ile-[Cys-Val-Val-Gln-Asp-Trp-Gly-His-His-Arg-Cys]-Thr (SEQID NO: 8), with the disulfide bond between the two cysteines denoted bybrackets. Compstatin is an N-terminal cyclic region of a larger peptide(SEQ ID NO: 1 in U.S. Pat. No. 6,319,897) that also shows complementinhibiting activity. In addition, a number of fragments and variants ofcompstatin inhibit complement, some of them having a higher inhibitoryactivity than compstatin itself Any of these peptides are of use in thecompositions and methods of the present invention. For example, peptidesdesignated by SEQ ID NOs: 13, 15, 20, 21, and 22 in U.S. Pat. No.6,319,897 show complement inhibiting activity and are of use. In certainembodiments of the invention a peptide having higher complementinhibiting activity than compstatin, e.g., at least 5-fold higheractivity, at least 10-fold higher activity, etc., is used.

A variety of compstatin analogs that have higher complement inhibitingactivity than compstatin have been synthesized. Certain of these aredescribed in WO2004/026328 (PCT/US2003/029653), Morikis, D., et al.,Biochem Soc Trans. 32(Pt 1):28-32, 2004, Mallik, B., et al., J. Med.Chem., 274-286, 2005, and/or in Katragadda, M., et al. J. Med. Chem.,49: 4616-4622, 2006, all of which are incorporated herein by reference.Any of the complement inhibiting peptides and peptidomimetics describedtherein can be used in the present invention. For example, SEQ ID NOs:4-13 as described in WO2004/026328 can be used in the present invention.

Compstatin and any of its analogs may be acetylated or amidated, e.g.,at the N-terminus and/or C-terminus. For example, compstatin and any ofits analogs may be acetylated at the N-terminus and amidated at theC-terminus. Consistent with usage in the art, “compstatin” as usedherein, and the activities of compstatin analogs described hereinrelative to that of compstatin, refer to compstatin amidated at theC-terminus (Mallik, 2005, supra).

Concatamers or multimers of compstatin or a complement inhibiting analogthereof are also of use in the present invention.

A supramolecular complex comprising compstatin and/or one or morecomplement inhibiting analogs thereof is also an aspect of the presentinvention and of use in the methods of the invention.

As used herein, the term “compstatin analog” includes compstatin and anycomplement inhibiting analog thereof. The term “compstatin analog”encompasses compstatin and other compounds designed or identified basedon compstatin and whose complement inhibiting activity is at least 50%as great as that of compstatin as measured, e.g., using any complementactivation assay accepted in the art or substantially similar orequivalent assays. Certain compstatin analogs and suitable assays aredescribed in U.S. Pat. No. 6,319,897, WO2004/026328, Morikis, supra,Mallik, supra, and/or Katragadda 2006, supra. The assay may, forexample, measure alternative pathway-mediated erythrocyte lysis or be anELISA assay (see Examples 4 and 5). WO2004/026328, Morikis, supra,Mallik, supra, and Katragadda 2006, supra, among other references,describe compstatin analogs having higher activity than compstatin andmethods for determining their ability to inhibit complement activation.Additional compstatin analogs are an aspect of this invention. Theinvention includes embodiments in which any one or more of thecompstatin analogs or compositions described herein is used in any themethods of treatment described herein.

The activity of a compstatin analog may be expressed in terms of itsIC₅₀ (the concentration of the compound that inhibits complementactivation by 50%), with a lower IC₅₀ indicating a higher activity asrecognized in the art. The activity of a preferred compstatin analog foruse in the present invention is at least as great as that of compstatin.It is noted that certain modifications known to reduce or eliminatecomplement inhibiting activity and may be explicitly excluded from anyembodiment of the invention. The IC₅₀ of compstatin has been measured as12 μM using an alternative pathway-mediated erythrocyte lysis assay(WO2004/026328). In one embodiment, the IC₅₀ of the compstatin analog isno more than the IC₅₀ of compstatin. In certain embodiments of theinvention the activity of the compstatin analog is between 2 and 99times that of compstatin (i.e., the analog has an IC₅₀ that is less thanthe IC₅₀ of compstatin by a factor of between 2 and 99). For example,the activity may be between 10 and 50 times as great as that ofcompstatin, or between 50 and 99 times as great as that of compstatin.In certain embodiments of the invention the activity of the compstatinanalog is between 99 and 264 times that of compstatin. For example, theactivity may be 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200,210, 220, 230, 240, 250, 260, or 264 times as great as that ofcompstatin. In certain embodiments the activity is between 264 and 300,300 and 350, 350 and 400, or 400 and 500 times as great as that ofcompstatin. The invention further contemplates compstatin analogs havingactivities between 500 and 1000 times that of compstatin.

The K_(d) of compstatin binding to C3 has been measured as 1.3 μM usingisothermal titration calorimetry (Katragadda, et al., J. Biol. Chem.,279(53), 54987-54995, 2004). Binding affinity of a variety of compstatinanalogs for C3 has been correlated with their activity, with a lowerK_(d) indicating a higher binding affinity, as recognized in the art. Alinear correlation between binding affinity and activity was shown forcertain analogs tested (Katragadda, 2004, supra; Katragadda 2006,supra). In certain embodiments of the invention the compstatin analogbinds to C3 with a K_(d) of between 0.1 μM and 1.0 μM, between 0.05 μmMand 0.1 μM, between 0.025 μM and 0.05 μM, between 0.015 μM and 0.025 μM,between 0.01 μM and 0.015 μM, or between 0.001 μM and 0.01 μM. Incertain embodiments the IC₅₀ of the compstatin analog is between about0.2 μM and about 0.5 μM. In certain embodiments the IC₅₀ of thecompstatin analog is between about 0.1 μM and about 0.2 μM. In certainembodiments the IC₅₀ of the compstatin analog is between about 0.05 μMand about 0.1 μM. In certain embodiments the IC₅₀ of the compstatinanalog is between about 0.001 μM and about 0.05 μM.

Compounds “designed or identified based on compstatin” include, but arenot limited to, compounds that comprise an amino acid chain whosesequence is obtained by (i) modifying the sequence of compstatin (e.g.,replacing one or more amino acids of the sequence of compstatin with adifferent amino acid or amino acid analog, inserting one or more aminoacids or amino acid analogs into the sequence of compstatin, or deletingone or more amino acids from the sequence of compstatin); (ii) selectionfrom a phage display peptide library in which one or more amino acids ofcompstatin is randomized, and optionally further modified according tomethod (i); or (iii) identified by screening for compounds that competewith compstatin or any analog thereof obtained by methods (i) or (ii)for binding to C3 or a fragment thereof. Many useful compstatin analogscomprise a hydrophobic cluster, a β-turn, and a disulfide bridge.

In certain embodiments of the invention the sequence of the compstatinanalog comprises or consists essentially of a sequence that is obtainedby making 1, 2, 3, or 4 substitutions in the sequence of compstatin,i.e., 1, 2, 3, or 4 amino acids in the sequence of compstatin isreplaced by a different standard amino acid or by a non-standard aminoacid. In certain embodiments of the invention the amino acid at position4 is altered. In certain embodiments of the invention the amino acid atposition 9 is altered. In certain embodiments of the invention the aminoacids at positions 4 and 9 are altered. In certain embodiments of theinvention only the amino acids at positions 4 and 9 are altered. Incertain embodiments of the invention the amino acid at position 4 or 9is altered, or in certain embodiments both amino acids 4 and 9 arealtered, and in addition up to 2 amino acids located at positionsselected from 1, 7, 10, 11, and 13 are altered. In certain embodimentsof the invention the amino acids at positions 4, 7, and 9 are altered.In certain embodiments of the invention amino acids at position 2, 12,or both are altered, provided that the alteration preserves the abilityof the compound to be cyclized. Such alteration(s) at positions 2 and/or12 may be in addition to the alteration(s) at position 1, 4, 7, 9, 10,11, and/or 13. Optionally the sequence of any of the compstatin analogswhose sequence is obtained by replacing one or more amino acids ofcompstatin sequence further includes up to 1, 2, or 3 additional aminoacids at the C-terminus. In one embodiment, the additional amino acid isGly. Optionally the sequence of any of the compstatin analogs whosesequence is obtained by replacing one or more amino acids of compstatinsequence further includes up to 5, or up to 10 additional amino acids atthe C-terminus. It should be understood that compstatin analogs may haveany one or more of the characteristics or features of the variousembodiments described herein, and characteristics or features of anyembodiment may additionally characterize any other embodiment describedherein, unless otherwise stated or evident from the context. In certainembodiments of the invention the sequence of the compstatin analogcomprises or consists essentially of a sequence shown in the upperportion of FIG. 2, in which X4 and X9 represent modifiable side chains.

Compstatin and certain compstatin analogs having somewhat greateractivity than compstatin contain only standard amino acids (“standardamino acids” are glycine, leucine, isoleucine, valine, alanine,phenylalanine, tyrosine, tryptophan, aspartic acid, asparagine, glutamicacid, glutamine, cysteine, methionine, arginine, lysine, proline,serine, threonine and histidine). Certain compstatin analogs havingimproved activity incorporate one or more non-standard amino acids.Useful non-standard amino acids include singly and multiply halogenated(e.g., fluorinated) amino acids, D-amino acids, homo-amino acids,N-alkyl amino acids, dehydroamino acids, aromatic amino acids (otherthan phenylalanine, tyrosine and tryptophan), ortho-, meta- orpara-aminobenzoic acid, phospho-amino acids, methoxylated amino acids,and α,α-disubstituted amino acids. In certain embodiments of theinvention, a compstatin analog is designed by replacing one or moreL-amino acids in a compstatin analog described elsewhere herein with thecorresponding D-amino acid. Such compounds and methods of use thereofare an aspect of the invention. Exemplary non-standard amino acids ofuse include 2-naphthylalanine (2-NaI), 1-naphthylalanine (1-NaI),2-indanylglycine carboxylic acid (2Ig1), dihydrotrpytophan (Dht),4-benzoyl-L-phenylalanine (Bpa), 2-α-aminobutyric acid (2-Abu),3-α-aminobutyric acid (3-Abu), 4-α-aminobutyric acid (4-Abu),cyclohexylalanine (Cha), homocyclohexylalanine (hCha),4-fluoro-L-tryptophan (4fW), 5-fluoro-L-tryptophan (5fW),6-fluoro-L-tryptophan (6fW), 4-hydroxy-L-tryptophan (40H—W),5-hydroxy-L-tryptophan (5OH—W), 6-hydroxy-L-tryptophan (6OH—W),1-methyl-L-tryptophan (1MeW), 4-methyl-L-tryptophan (4MeW),5-methyl-L-tryptophan (5MeW), 7-aza-L-tryptophan (7aW),α-methyl-L-tryptophan (αMeW), β-methyl-L-tryptophan (βMeW),N-methyl-L-tryptophan (NMeW), ornithine (orn), citrulline, norleucine,γ-glutamic acid, etc.

In certain embodiments of the invention the compstatin analog comprisesone or more Trp analogs (e.g., at position 4 and/or 7 relative to thesequence of compstatin). Exemplary Trp analogs are mentioned above. Seealso Beene, et. al. Biochemistry 41: 10262-10269, 2002 (describing,inter alia, singly- and multiply-halogenated Trp analogs); Babitzke &Yanofsky, J. Biol. Chem. 270: 12452-12456, 1995 (describing, inter alia,methylated and halogenated Trp and other Trp and indole analogs); andU.S. Pat. Nos. 6,214,790, 6,169,057, 5,776,970, 4,870,097, 4,576,750 and4,299,838. Other Trp analogs include variants that are substituted(e.g., by a methyl group) at the α or β carbon and, optionally, also atone or more positions of the indole ring. Amino acids comprising two ormore aromatic rings, including substituted, unsubstituted, oralternatively substituted variants thereof, are of interest as Trpanalogs.

In certain embodiments the Trp analog has increased hydrophobiccharacter relative to Trp. For example, the indole ring may besubstituted by one or more alkyl (e.g., methyl) groups. In certainembodiments the Trp analog participates in a hydrophobic interactionwith C3. Such a Trp analog may be located, e.g., at position 4 relativeto the sequence of compstatin. In certain embodiments the Trp analogcomprises a substituted or unsubstituted bicyclic aromatic ringcomponent or two or more substituted or unsubstituted monocyclicaromatic ring components.

In certain embodiments the Trp analog has increased propensity to formhydrogen bonds with C3 relative to Trp but does not have increasedhydrophobic character relative to Trp. The Trp analog may have increasedpolarity relative to Trp and/or an increased ability to participate inan electrostatic interaction with a hydrogen bond donor on C3. Certainexemplary Trp analogs with an increased hydrogen bond forming charactercomprise an electronegative substituent on the indole ring. Such a Trpanalog may be located, e.g., at position 7 relative to the sequence ofcompstatin.

In certain embodiments of the invention the compstatin analog comprisesone or more Ala analogs (e.g., at position 9 relative to the sequence ofcompstatin), e.g., Ala analogs that are identical to Ala except thatthey include one or more CH₂ groups in the side chain. In certainembodiments the Ala analog is an unbranched single methyl amino acidsuch as 2-Abu. In certain embodiments of the invention the compstatinanalog comprises one or more Trp analogs (e.g., at position 4 and/or 7relative to the sequence of compstatin) and an Ala analog (e.g., atposition 9 relative to the sequence of compstatin).

In certain embodiments of the invention the compstatin analog is acompound that comprises a peptide that has a sequence of(X′aa)_(n)-Gln-Asp-Xaa-Gly-(X″aa)_(m), (SEQ ID NO: 2) wherein each X′aaand each X″aa is an independently selected amino acid or amino acidanalog, wherein Xaa is Trp or an analog of Trp, and wherein n>1 and m>1and n+m is between 5 and 21. The peptide has a core sequence ofGln-Asp-Xaa-Gly, where Xaa is Trp or an analog of Trp, e.g., an analogof Trp having increased propensity to form hydrogen bonds with an H-bonddonor relative to Trp but, in certain embodiments, not having increasedhydrophobic character relative to Trp. For example, the analog may beone in which the indole ring of Trp is substituted with anelectronegative moiety, e.g., a halogen such as fluorine. In oneembodiment Xaa is 5-fluorotryptophan. Absent evidence to the contrary,one of skill in the art would recognize that any non-naturally occurringpeptide whose sequence comprises this core sequence and that inhibitscomplement activation and/or binds to C3 will have been designed basedon the sequence of compstatin. In an alternative embodiment Xaa is anamino acid or amino acid analog other than a Trp analog that allows theGln-Asp-Xaa-Gly peptide to form a β-turn.

In certain embodiments of the invention the peptide has a core sequenceof X′aa-Gln-Asp-Xaa-Gly (SEQ ID NO: 3), where X′aa and Xaa are selectedfrom Trp and analogs of Trp. In certain embodiments of the invention thepeptide has a core sequence of X′aa-Gln-Asp-Xaa-Gly (SEQ ID NO: 3),where X′aa and Xaa are selected from Trp, analogs of Trp, and otheramino acids or amino acid analogs comprising at least one aromatic ring.In certain embodiments of the invention the core sequence forms a β-turnin the context of the peptide. The β-turn may be flexible, allowing thepeptide to assume two or more conformations as assessed for example,using nuclear magnetic resonance (NMR). In certain embodiments X′aa isan analog of Trp that comprises a substituted or unsubstituted bicyclicaromatic ring component or two or more substituted or unsubstitutedmonocyclic aromatic ring components. In certain embodiments of theinvention X′aa is selected from the group consisting of2-napthylalanine, 1-napthylalanine, 2-indanylglycine carboxylic acid,dihydrotryptophan, and benzoylphenylalanine 1n certain embodiments ofthe invention X′aa is an analog of Trp that has increased hydrophobiccharacter relative to Trp. For example, X′aa may be 1-methyltryptophan.In certain embodiments of the invention Xaa is an analog of Trp that hasincreased propensity to form hydrogen bonds relative to Trp but, incertain embodiments, not having increased hydrophobic character relativeto Trp. In certain embodiments of the invention the analog of Trp thathas increased propensity to form hydrogen bonds relative to Trpcomprises a modification on the indole ring of Trp, e.g., at position 5,such as a substitution of a halogen atom for an H atom at position 5.For example, Xaa may be 5-fluorotryptophan.

In certain embodiments of the invention the peptide has a core sequenceof X′aa-Gln-Asp-Xaa-Gly-X″aa (SEQ ID NO: 4), where X′aa and Xaa are eachindependently selected from Trp and analogs of Trp and X″aa is selectedfrom H is, Ala, analogs of Ala, Phe, and Trp. In certain embodiments ofthe invention X′aa is an analog of Trp that has increased hydrophobiccharacter relative to Trp, such as 1-methyltryptophan or another Trpanalog having an alkyl substituent on the indole ring (e.g., at position1, 4, 5, or 6). In certain embodiments X′aa is an analog of Tip thatcomprises a substituted or unsubstituted bicyclic aromatic ringcomponent or two or more substituted or unsubstituted monocyclicaromatic ring components. In certain embodiments of the invention X′aais selected from the group consisting of 2-napthylalanine,1-napthylalanine, 2-indanylglycine carboxylic acid, dihydrotryptophan,and benzoylphenylalanine 1n certain embodiments of the invention Xaa isan analog of Trp that has increased propensity to form hydrogen bondswith C3 relative to Trp but, in certain embodiments, not havingincreased hydrophobic character relative to Trp. In certain embodimentsof the invention the analog of Trp that has increased propensity to formhydrogen bonds relative to Trp comprises a modification on the indolering of Trp, e.g., at position 5, such as a substitution of a halogenatom for an H atom at position 5. For example, Xaa may be5-fluorotryptophan. In certain embodiments X″aa is Ala or an analog ofAla such as Abu or another unbranched single methyl amino acid. Incertain embodiments of the invention the peptide has a core sequence ofX′aa-Gln-Asp-Xaa-Gly-X″aa (SEQ ID NO: 4), where X′aa and Xaa are eachindependently selected from Trp, analogs of Trp, and amino acids oramino acid analogs comprising at least one aromatic side chain, and X″aais selected from His, Ala, analogs of Ala, Phe, and Trp. In certainembodiments X″aa is selected from analogs of Tip, aromatic amino acids,and aromatic amino acid analogs.

In certain preferred embodiments of the invention the peptide is cyclic.The peptide may be cyclized via a bond between any two amino acids, oneof which is (X′aa)_(n) and the other of which is located within(X″aa)_(m). In certain embodiments the cyclic portion of the peptide isbetween 9 and 15 amino acids in length, e.g., 10-12 amino acids inlength. In certain embodiments the cyclic portion of the peptide is 11amino acids in length, with a bond (e.g., a disulfide bond) betweenamino acids at positions 2 and 12. For example, the peptide may be 13amino acids long, with a bond between amino acids at positions 2 and 12resulting in a cyclic portion 11 amino acids in length.

In certain embodiments the peptide comprises or consists of the sequenceX′aa1-X′aa2-X′aa3-X′aa4-Gln-Asp-Xaa-Gly-X″aa1-X″aa2-X″aa3-X″aa4-X″aa5(SEQ ID NO: 5). In certain embodiments X′aa4 and Xaa are selected fromTrp and analogs of Trp, and X′aa1, X′aa2, X′aa3, X″aa1, X″aa2, X″aa3,X″aa4, and X″aa5 are independently selected from among amino acids andamino acid analogs. In certain embodiments X′aa4 and Xaa are selectedfrom aromatic amino acids and aromatic amino acid analogs. Any one ormore of X′aa1, X′aa2, X′aa3, X″aa1, X″aa2, X″aa3, X″aa4, and X″aa5 maybe identical to the amino acid at the corresponding position incompstatin. In one embodiment, X″aa1 is Ala or a single methylunbranched amino acid. The peptide may be cyclized via a covalent bondbetween (i) X′aa1, X′aa2, or X′aa3; and (ii) X″aa2, X″aa3, X″aa4 orX″aa5. In one embodiment the peptide is cyclized via a covalent bondbetween X′aa2 and X″aa4. In one embodiment the covalently bound aminoacid are each Cys and the covalent bond is a disulfide (S—S) bond. Inother embodiments the covalent bond is a C—C, C—O, C—S, or C—N bond. Incertain embodiments one of the covalently bound residues is an aminoacid or amino acid analog having a side chain that comprises a primaryor secondary amine, the other covalently bound residue is an amino acidor amino acid analog having a side chain that comprises a carboxylicacid group, and the covalent bond is an amide bond. Amino acids or aminoacid analogs having a side chain that comprises a primary or secondaryamine include lysine and diaminocarboxylic acids of general structureNH₂(CH₂)_(n)CH(NH₂)COOH such as 2,3-diaminopropionic acid (dapa),2,4-diaminobutyric acid (daba), and ornithine (orn), wherein n=1 (dapa),2 (daba), and 3 (orn), respectively. Examples of amino acids having aside chain that comprises a carboxylic acid group include dicarboxylicamino acids such as glutamic acid and aspartic acid. Analogs such asbeta-hydroxy-L-glutamic acid may also be used.

In certain embodiments, the compstatin analog is a compound thatcomprises a peptide having a sequence:

Xaa1-Cys-Val-Xaa2-Gln-Asp-Xaa2*-Gly-Xaa3-His-Arg-Cys-Xaa4 (SEQ ID NO:6); wherein:

Xaa1 is Ile, Val, Leu, B¹-Ile, B¹-Val, B¹-Leu or a dipeptide comprisingGly-Ile or B¹-Gly-Ile, and B¹ represents a first blocking moiety;Xaa2 and Xaa2* are independently selected from Trp and analogs of Trp;Xaa3 is His, Ala or an analog of Ala, Phe, Trp, or an analog of Trp;Xaa4 is L-Thr, D-Thr, Ile, Val, Gly, a dipeptide selected from Thr-Alaand Thr-Asn, or a tripeptide comprising Thr-Ala-Asn, wherein a carboxyterminal —OH of any of the L-Thr, D-Thr, Ile, Val, Gly, Ala, or Asnoptionally is replaced by a second blocking moiety B²; and the two Cysresidues are joined by a disulfide bond.

In other embodiments Xaa1 is absent or is any amino acid or amino acidanalog, and Xaa2, Xaa2*, Xaa3, and Xaa4 are as defined above. If Xaa1 isabsent, the N-terminal Cys residue may have a blocking moiety B¹attached thereto.

In another embodiment, Xaa4 is any amino acid or amino acid analog andXaa1, Xaa2, Xaa2*, and Xaa3 are as defined above. In another embodimentXaa4 is a dipeptide selected from the group consisting of: Thr-Ala andThr-Asn, wherein the carboxy terminal —OH or the Ala or Asn isoptionally replaced by a second blocking moiety B².

In any of the embodiments of the compstatin analog of SEQ ID NO: 6, Xaa2may be Trp.

In any of the embodiments of the compstatin analog of SEQ ID NO: 6, Xaa2may be an analog of Trp comprising a substituted or unsubstitutedbicyclic aromatic ring component or two or more substituted orunsubstituted monocyclic aromatic ring components. For example, theanalog of Trp may be selected from 2-naphthylalanine (2-NaI),1-naphthylalanine (1-NaI), 2-indanylglycine carboxylic acid (Ig1),dihydrotrpytophan (Dht), and 4-benzoyl-L-phenylalanine.

In any of the embodiments of the compstatin analog of SEQ ID NO: 6, Xaa2may be an analog of Trp having increased hydrophobic character relativeto Trp. For example, the analog of Trp may be selected from1-methyltryptophan, 4-methyltryptophan, 5-methyltryptophan, and6-methyltryptophan. In one embodiment, the analog of Trp is1-methyltryptophan. In one embodiment, Xaa2 is 1-methyltryptophan, Xaa2*is Trp, Xaa3 is Ala, and the other amino acids are identical to those ofcompstatin.

In any of the embodiments of the compstatin analog of SEQ ID NO: 6,Xaa2* may be an analog of Trp such as an analog of Trp having increasedhydrogen bond forming propensity with C3 relative to Trp, which, incertain embodiments, does not have increased hydrophobic characterrelative to Trp. In certain embodiments the analog of Trp comprises anelectronegative substituent on the indole ring. For example, the analogof Trp may be selected from 5-fluorotryptophan and 6-fluorotryptophan.

In certain embodiments of the invention Xaa2 is Tip and Xaa2* is ananalog of Trp having increased hydrogen bond forming propensity with C3relative to Trp which, in certain embodiments, does not have increasedhydrophobic character relative to Trp. In certain embodiments of thecompstatin analog of SEQ ID NO: 6, Xaa2 is analog of Trp havingincreased hydrophobic character relative to Tip such as an analog of Trpselected from 1-methyltryptophan, 4-methyltryptophan,5-methyltryptophan, and 6-methyltryptophan, and Xaa2* is an analog ofTrp having increased hydrogen bond forming propensity with C3 relativeto Trp which, in certain embodiments, does not have increasedhydrophobic character relative to Trp. For example, in one embodimentXaa2 is methyltryptophan and Xaa2* is 5-fluorotryptophan.

In certain of the afore-mentioned embodiments, Xaa3 is Ala. In certainof the afore-mentioned embodiments Xaa3 is a single methyl unbranchedamino acid, e.g., Abu.

The invention further provides compstatin analogs of SEQ ID NO: 6, asdescribed above, wherein Xaa2 and Xaa2* are independently selected fromTrp, analogs of Trp, and other amino acids or amino acid analogs thatcomprise at least one aromatic ring, and Xaa3 is His, Ala or an analogof Ala, Phe, Trp, an analog of Trp, or another aromatic amino acid oraromatic amino acid analog.

In certain embodiments of the invention the blocking moiety present atthe N- or C-terminus of any of the compstatin analogs described hereinis any moiety that stabilizes a peptide against degradation that wouldotherwise occur in mammalian (e.g., human or non-human primate) blood orvitreous. For example, blocking moiety B¹ could be any moiety thatalters the structure of the N-terminus of a peptide so as to inhibitcleavage of a peptide bond between the N-terminal amino acid of thepeptide and the adjacent amino acid. Blocking moiety B² could be anymoiety that alters the structure of the C-terminus of a peptide so as toinhibit cleavage of a peptide bond between the C-terminal amino acid ofthe peptide and the adjacent amino acid. Any suitable blocking moietiesknown in the art could be used. In certain embodiments of the inventionblocking moiety B¹ comprises an acyl group (i.e., the portion of acarboxylic acid that remains following removal of the —OH group). Theacyl group typically comprises between 1 and 12 carbons, e.g., between 1and 6 carbons. For example, in certain embodiments of the inventionblocking moiety B¹ isselected from the group consisting of: formyl,acetyl, proprionyl, butyryl, isobutyryl, valeryl, isovaleryl, etc. Inone embodiment, the blocking moiety B¹ isan acetyl group, i.e., Xaa1 isAc-Ile, Ac-Val, Ac-Leu, or Ac-Gly-Ile.

In certain embodiments of the invention blocking moiety B² is a primaryor secondary amine (—NH₂ or —NHR′, wherein R is an organic moiety suchas an alkyl group).

In certain embodiments of the invention blocking moiety B¹ is any moietythat neutralizes or reduces the negative charge that may otherwise bepresent at the N-terminus at physiological pH. In certain embodiments ofthe invention blocking moiety B² is any moiety that neutralizes orreduces the negative charge that may otherwise be present at theC-terminus at physiological pH.

In certain embodiments of the invention, the compstatin analog isacetylated or amidated at the N-terminus and/or C-terminus,respectively. A compstatin analog may be acetylated at the N-terminus,amidated at the C-terminus, and or both acetylated at the N-terminus andamidated at the C-terminus. In certain embodiments of the invention acompstatin analog comprises an alkyl or aryl group at the N-terminusrather than an acetyl group.

In certain embodiments, the compstatin analog is a compound thatcomprises a peptide having a sequence:

Xaa1-Cys-Val-Xaa2-Gln-Asp-Xaa2*-Gly-Xaa3-His-Arg-Cys-Xaa4 (SEQ ID NO:7); wherein:

Xaa1 is Ile, Val, Leu, Ac-Ile, Ac-Val, Ac-Leu or a dipeptide comprisingGly-Ile or Ac-Gly-Ile;Xaa2 and Xaa2* are independently selected from Trp and analogs of Trp;Xaa3 is His, Ala or an analog of Ala, Phe, Trp, or an analog of Trp;Xaa4 is L-Thr, D-Thr, Ile, Val, Gly, a dipeptide selected from Thr-Alaand Thr-Asn, or a tripeptide comprising Thr-Ala-Asn, wherein a carboxyterminal —OH of any of L-Thr, D-Thr, Ile, Val, Gly, Ala, or Asnoptionally is replaced by —NH₂; andthe two Cys residues are joined by a disulfide bond.

Xaa1, Xaa2, Xaa2*, Xaa3, and Xaa4 are as described above for the variousembodiments of SEQ ID NO: 6. For example, in certain embodiments Xaa2*is Trp. In certain embodiments Xaa2 is an analog of Trp having increasedhydrophobic character relative to Trp, e.g., 1-methyltryptophan. Incertain embodiments Xaa3 is Ala. In certain embodiments Xaa3 is a singlemethyl unbranched amino acid.

In certain embodiments of the invention Xaa1 is Ile and Xaa4 is L-Thr.

In certain embodiments of the invention Xaa1 is Ile, Xaa2* is Tip, andXaa4 is L-Thr.

The invention further provides compstatin analogs of SEQ ID NO: 7, asdescribed above, wherein Xaa2 and Xaa2* are independently selected fromTrp, analogs of Trp, other amino acids or aromatic amino acid analogs,and

Xaa3 is His, Ala or an analog of Ala, Phe, Tip, an analog of Trp, oranother aromatic amino acid or aromatic amino acid analog.

Table 1 provides a non-limiting list of compstatin analogs useful in thepresent invention. The analogs are referred to in abbreviated form inthe left column by indicating specific modifications at designatedpositions (1-13) as compared to the parent peptide, compstatin (amidatedat the C-terminus). Unless otherwise indicated, peptides are amidated atthe C-terminus. Bold text is used to indicate certain modifications.Activity relative to compstatin (in this case compstatin amidated at theC-terminus) is based on published data and assays described therein(WO2004/026326, Mallik, 2005; Katragadda, 2006). Where multiplepublications reporting an activity were consulted, the more recentlypublished value is used, and it will be recognized that values may beadjusted in the case of differences between assays. It will also beappreciated that the peptides listed in Table 1 are cyclized via adisulfide bond between the two Cys residues when used in the therapeuticcompositions and methods of the invention.

TABLE 1 SEQ ID Activity over Peptide Sequence NO: compstatin compstatinH-ICVVQDWGHHRCT-CONH2 8 * Ac-compstatin Ac-ICVVQDWGHHRCT-CONH2 9  3xmoreAc-V4Y/H9A Ac-ICV Y QDWG A HRCT-CONH2 10 14xmore Ac-V4W/H9A —OH Ac-ICV WQDWG A HRCT-COOH 11 27xmore Ac-V4W/H9A Ac-ICV W QDWG A HRCT-CONH2 1245xmore Ac-V4W/H9A/T13dT —OH Ac-ICV W QDWG A HRC dT -COOH 13 55xmoreAc-V4(2-Nal)/H9A Ac-ICV( 2-Nal )QDWG A HRCT-CONH2 14 99xmoreAc V4(2-Nal)/H9A —OH Ac-ICV( 2-Nal )QDWG A HRCT-COOH 15 38xmoreAc V4(1-Nal)/H9A —OH Ac-ICV( 1-Nal )QDWG A HRCT-COOH 16 30xmoreAc-V42Igl/H9A Ac-ICV(2- Igl )QDWG A HRCT-CONH2 17 39xmoreAc-V42Igl/H9A —OH Ac-ICV(2- Igl )QDWG A HRCT-COOH 18 37xmoreAc-V4Dht/H9A —OH Ac-ICV Dht QDWG A HRCT-COOH 19  5xmoreAc-V4(Bpa)/H9A —OH Ac-ICV( Bpa )QDWG A HRCT-COOH 20 49xmoreAc-V4(Bpa)/H9A Ac-ICV( Bpa )QDWG A HRCT-CONH2 21 86xmoreAc-V4(Bta)/H9A —OH Ac-ICV( Bta )QDWG A HRCT-COOH 22 65xmoreAc-V4(Bta)/H9A Ac-ICV( Bta )QDWG A HRCT-CONH2 23 64xmoreAc-V4W/H9(2-Abu) Ac-ICV W QDWG(2- Abu )HRCT-CONH2 24 64xmore+G/V4W/H9A +AN —OH H- G ICV W QDWG A HRCTA N -COOH 25 38xmoreAc-V4(5fW)/H9A Ac-ICV( 5fW )QDWG A HRCT-CONH₂ 26 31xmoreAc-V4(5-MeW)/H9A Ac-ICV( 5-methyl-W )QDWG A HRCT-CONH₂ 27 67xmoreAc-V4(1-MeW)/H9A Ac-ICV( 1-methyl-W )QDWG A HRCT-CONH₂ 28 264xmore Ac-V4W/W7(5fW)/H9A Ac-ICV W QD( 5fW )G A HRCT-CONH₂ 29 121xmore Ac-V4(5fW)/W7(5fW)/H9A Ac-ICV( 5fW )QD( 5fW )G A HRCT-CONH₂ 30 NAAc-V4(5-MeW)/W7(5fW)H9A Ac-ICV( 5-methyl-W )QD( 5fW )G A HRCT- 31 NACONH₂ Ac-V4(1MeW)/W7(5fW)/H9A Ac-ICV(1-methyl-W)QD(5fW)G A HRCT- 32264xmore  CONH₂ NA = not available

In certain embodiments of the compositions and methods of the inventionthe compstatin analog has a sequence selected from sequences 9-32. Incertain embodiments of the compositions and methods of the invention thecompstatin analog has a sequence selected from SEQ ID NOs: 14, 21, 28,29, and 32. In certain embodiments of the compositions and methods ofthe invention the compstatin analog has a sequence selected from SEQ IDNOs: 30 and 31. In one embodiment of the compositions and methods of theinvention the compstatin analog has a sequence of SEQ ID NO: 28. In oneembodiment of the methods of the invention the compstatin analog has asequence of SEQ ID NO: 32.

The invention further provides compstatin analogs, having sequences asset forth in Table 1, but where the Ac-group is replaced by an alternateblocking moiety B¹, as described above. The invention further providescompstatin analogs, having sequences as set forth in Table 1, but wherethe —NH₂ group is replaced by an alternate blocking moiety B², asdescribed above.

In one embodiment, the compstatin analog binds to substantially the sameregion of the β chain of human C3 as does compstatin. In one embodimentthe compstatin analog is a compound that binds to a fragment of theC-terminal portion of the β chain of human C3 having a molecular weightof about 40 kDa to which compstatin binds (Soulika, A. M., et al., Mol.Immunol., 35:160, 1998; Soulika, A. M., et al., Mol. Immunol.43(12):2023-9, 2006). In certain embodiments the compstatin analog is acompound that binds to the binding site of compstatin as determined in acompstatin-C3 structure, e.g., a crystal structure or NMR-derived 3Dstructure. In certain embodiments the compstatin analog is a compoundthat could substitute for compstatin in a compstatin-C3 structure andwould form substantially the same intermolecular contacts with C3 ascompstatin. In certain embodiments the compstatin analog is a compoundthat binds to the binding site of a peptide having a sequence set forthin Table 1, e.g., SEQ ID NO: 14, 21, 28, 29, or 32 in a peptide-C3structure, e.g., a crystal structure. In certain embodiments thecompstatin analog is a compound that binds to the binding site of apeptide having SEQ ID NO: 30 or 31 in a peptide-C3 structure, e.g., acrystal structure. In certain embodiments the compstatin analog is acompound that could substitute for the peptide of SEQ ID NO: 9-32, e.g.,SEQ ID NO: 14, 21, 28, or 32 in a peptide-C3 structure and would formsubstantially the same intermolecular contacts with C3 as the peptide.In certain embodiments the compstatin analog is a compound that couldsubstitute for the peptide of SEQ ID NO: 30 or 31 in a peptide-C3structure and would form substantially the same intermolecular contactswith C3 as the peptide.

One of ordinary skill in the art will readily be able to determinewhether a compstatin analog binds to a fragment of the C-terminalportion of the β chain of C3 using routine experimental methods. Forexample, one of skill in the art could synthesize a photocrosslinkableversion of the compstatin analog by including a photo-crosslinking aminoacid such as p-benzoyl-L-phenylalanine (Bpa) in the compound, e.g., atthe C-terminus of the sequence (Soulika, A. M., et al, supra).Optionally additional amino acids, e.g., an epitope tag such as a FLAGtag or an HA tag could be included to facilitate detection of thecompound, e.g., by Western blotting. The compstatin analog is incubatedwith the fragment and crosslinking is initiated. Colocalization of thecompstatin analog and the C3 fragment indicates binding. Surface plasmonresonance may also be used to determine whether a compstatin analogbinds to the compstatin binding site on C3 or a fragment thereof. One ofskill in the art would be able to use molecular modeling softwareprograms to predict whether a compound would form substantially the sameintermolecular contacts with C3 as would compstatin or a peptide havingthe sequence of any of the peptides in Table 1, e.g., SEQ ID NO: 14, 21,28, 29, or 32, or in other embodiments SEQ ID NO: 30 or 31.

Compstatin analogs may be prepared by various synthetic methods ofpeptide synthesis known in the art via condensation of amino acidresidues, e.g., in accordance with conventional peptide synthesismethods, may be prepared by expression in vitro or in living cells fromappropriate nucleic acid sequences encoding them using methods known inthe art. For example, peptides may be synthesized using standardsolid-phase methodologies as described in Malik, supra, Katragadda,supra, and/or WO2004026328. Potentially reactive moieties such as aminoand carboxyl groups, reactive functional groups, etc., may be protectedand subsequently deprotected using various protecting groups andmethodologies known in the art. See, e.g., “Protective Groups in OrganicSynthesis”, 3^(rd) ed. Greene, T. W. and Wuts, P. G., Eds., John Wiley &Sons, New York: 1999. Peptides may be purified using standard approachessuch as reversed-phase HPLC. Separation of diasteriomeric peptides, ifdesired, may be performed using known methods such as reversed-phaseHPLC. Preparations may be lyophilized, if desired, and subsequentlydissolved in a suitable solvent, e.g., water. The pH of the resultingsolution may be adjusted, e.g. to physiological pH, using a base such asNaOH. Peptide preparations may be characterized by mass spectrometry ifdesired, e.g., to confirm mass and/or disulfide bond formation. See,e.g., Mallik, 2005, and Katragadda, 2006.

Compstatin Mimetics

The structure of compstatin is known in the art, and NMR structures fora number of compstatin analogs having higher activity than compstatinare also known (Malik, supra). Structural information may be used todesign compstatin mimetics.

In one embodiment, the compstatin mimetic is any compound that competeswith compstatin or any compstatin analog (e.g., a compstatin analogwhose sequence is set forth in Table 1) for binding to C3 or a fragmentthereof (such as a 40 kD fragment of the β chain to which compstatinbinds) and that has an activity equal to or greater than that ofcompstatin. The compstatin mimetic may be a peptide, nucleic acid, orsmall molecule. In certain embodiments the compstatin mimetic is acompound that binds to the binding site of compstatin as determined in acompstatin-C3 structure, e.g., a crystal structure or a 3-D structurederived from NMR experiments. In certain embodiments the compstatinmimetic is a compound that could substitute for compstatin in acompstatin-C3 structure and would form substantially the sameintermolecular contacts with C3 as compstatin. In embodiments thecompstatin mimetic is a compound that binds to the binding site of apeptide having a sequence set forth in Table 1, e.g., SEQ ID NO: 14, 21,28, 29, or 32, or in certain embodiments SEQ ID NO: 30 or 31, in apeptide-C3 structure. In certain embodiments the compstatin mimetic is acompound that could substitute for a peptide having a sequence set forthin Table 1, e.g., SEQ ID NO: 14, 21, 28, 29, or 32, or in certainembodiments SEQ ID NO: 30 or 31, in a peptide-C3 structure and wouldform substantially the same intermolecular contacts with C3 as thepeptide. In certain embodiments the compstatin mimetic has a non-peptidebackbone but has side chains arranged in a sequence designed based onthe sequence of compstatin.

One of skill in the art will appreciate that once a particular desiredconformation of a short peptide has been ascertained, methods fordesigning a peptide or peptidomimetic to fit that conformation are wellknown. See, e.g., G. R. Marshall (1993), Tetrahedron, 49: 3547-3558;Hruby and Nikiforovich (1991), in Molecular Conformation and BiologicalInteractions, P. Balaram & S. Ramasehan, eds., Indian Acad. of Sci.,Bangalore, PP. 429-455), Eguchi M, Kahn M., Mini Rev Med. Chem.,2(5):447-62, 2002. Of particular relevance to the present invention, thedesign of peptide analogs may be further refined by considering thecontribution of various side chains of amino acid residues, e.g., forthe effect of functional groups or for steric considerations asdescribed in the art for compstatin and analogs thereof, among others.

It will be appreciated by those of skill in the art that a peptide mimicmay serve equally well as a peptide for the purpose of providing thespecific backbone conformation and side chain functionalities requiredfor binding to C3 and inhibiting complement activation. Accordingly, itis contemplated as being within the scope of the present invention toproduce and utilize C3-binding, complement-inhibiting compounds throughthe use of either naturally-occurring amino acids, amino acidderivatives, analogs or non-amino acid molecules capable of being joinedto form the appropriate backbone conformation. A non-peptide analog, oran analog comprising peptide and non-peptide components, is sometimesreferred to herein as a “peptidomimetic” or “isosteric mimetic,” todesignate substitutions or derivations of a peptide that possesses muchthe same backbone conformational features and/or other functionalities,so as to be sufficiently similar to the exemplified peptides to inhibitcomplement activation. More generally, a compstatin mimetic is anycompound that would position pharmacophores similarly to theirpositioning in compstatin, even if the backbone differs.

The use of peptidomimetics for the development of high-affinity peptideanalogs is well known in the art. Assuming rotational constraintssimilar to those of amino acid residues within a peptide, analogscomprising non-amino acid moieties may be analyzed, and theirconformational motifs verified, by means of the Ramachandran plot (Hruby& Nikiforovich 1991), among other known techniques.

The invention encompasses use of virtual screening methods to identifycompstatin mimetics that bind to C3. Such methods may comprise use ofsuitable algorithms to computationally dock, score, and optionally ranka plurality of candidate structures. In one embodiment, an induced-fitalgorithm is employed. In one embodiment, the invention provides amethod comprising (i) providing a three-dimensional structure of C3 or aportion thereof to which compstatin binds; (ii) computationally dockinga plurality of molecular structures with the structure of C3; and (iii)selecting a molecular structure that binds to substantially the samesite as that to which a compstatin or an analog thereof binds. Any of awide variety of available software programs can be used to perform thevirtual screening method. Exemplary programs useful for flexiblemolecular docking include DOCK 4.0, FlexX 1.8, AutoDock 3.0, GOLD 1.2,ICM 2.8, and more recent versions thereof.

One of skill in the art will readily be able to establish suitablescreening assays to identify additional compstatin mimetics and toselect those having desired inhibitory activities. For example,compstatin or an analog thereof could be labeled (e.g., with aradioactive or fluorescent label) and contacted with C3 in the presenceof different concentrations of a test compound. The ability of the testcompound to diminish binding of the compstatin analog to C3 isevaluated. A test compound that significantly diminishes binding of thecompstatin analog to C3 is a candidate compstatin mimetic. For example,a test compound that diminishes steady-state concentration of acompstatin analog-C3 complex, or that diminishes the rate of formationof a compstatin analog-C3 complex by at least 25%, or by at least 50%,is a candidate compstatin mimetic. One of skill in the art willrecognize that a number of variations of this screening assay may beemployed. Compounds to be screened include natural products, librariesof aptamers, phage display libraries, compound libraries synthesizedusing combinatorial chemistry, etc. The invention encompassessynthesizing a combinatorial library of compounds based upon the coresequence described above and screening the library to identifycompstatin mimetics. Any of these methods could also be used to identifynew compstatin analogs having higher inhibitory activity than compstatinanalogs tested thus far.

Combination Therapies

The present invention contemplates the use of compstatin analogs andmimetics together with one or more other agents effective for treatmentof the retinal and other ocular conditions discussed herein, e.g., oneor more other complement inhibitors, angiogenesis inhibitors, etc.Suitable complement inhibitors include inhibitors of complementactivation such as viral complement control proteins (VCCPs) (e.g.,vaccinia complement control protein (VCP), smallpox inhibitor ofcomplement (SPICE)), peptides, etc. The invention specificallycontemplates use of any of the agents described in U.S. Ser. No.60/616,983, filed Oct. 8, 2004, U.S. Ser. No. 60/660,752, filed Mar. 11,2005, and U.S. patent application entitled VIRAL COMPLEMENT CONTROLPROTEINS FOR EYE DISORDERS, filed Oct. 8, 2005. These or othercomplement inhibitors may be administered together with compstatin or acomplement inhibiting analog thereof as part of a single composition orthe agents may be administered separately. The complement inhibitors maybe administered sequentially or concurrently and may be administered bythe same or different routes of administration. For example, certainagents may be more advantageously administered intravitreally and otheragents may be more advantageously administered in close proximity to,but outside of, the posterior segment of the eye, e.g., behind thesclera.

In one embodiment, the invention provides a method comprisingadministering a compstatin analog and an angiogenesis inhibitor to asubject suffering from or at risk of developing wet ARMD. The compstatinanalog and the angiogenesis inhibitor may be administered in eitherorder. In one embodiment, an angiogenesis inhibitor such as an anti-VEGFantibody, aptamer, or siRNA (e.g., Lucentis, Avastin, Macugen) isadministered by intravitreal injection using methods and amountsofangiogenesis inhibitor typically used in the art for treating wet ARMD.A compstatin analog is administered, e.g., by intravitreal injection, ata time up to 4 weeks following administration of the angiogenesisinhibitor, e.g., within 24, 48, or 72 hours after administration of theangiogenesis inhibitor, or within 1, 2, 3, or 4 weeks afteradministration of the angiogenesis inhibitor. In one embodiment thecompstatin analog is administered after the subject has shown afavorable response to the angiogenesis inhibitor, e.g., a decrease inretinal thickness (measured, e.g., using optical coherence tomography)or an improvement in visual acuity. In one embodiment, the compstatinanalog is administered in an ocular, e.g., intravitreal, insert. Inanother embodiment the compstatin analog is administered in amicroparticle or nanoparticle formulation. In certain embodiments thecompstatin analog is administered in an ocular insert ormicroparticle/nanoparticle formulation that contains between 100 and10,000 μg of a compstatin analog. In certain embodiments the compstatinanalog is administered in an ocular insert that contains between 100 and1,000 μg of a compstatin analog, e.g., between 100 and 500 μg. Incertain embodiments the compstatin analog is released from the insert ofmicroparticle/nanoparticle formulation at a rate between 0.1 and 5μg/day. In certain embodiments the compstatin analog is released fromthe insert of microparticle/nanoparticle formulation at a rate between0.5 and 5 μg/day. In certain embodiments the compstatin analog isreleased from the insert of microparticle/nanoparticle formulation at arate between 5 and 10 μg/day. In certain embodiments the compstatinanalog is released from the insert of microparticle/nanoparticleformulation at a rate between 10 and 20 μg/day. One aspect of theinvention comprises providing instructions to those of skill in the art,e.g., ophthalmologists, regarding methods for administering thecompstatin analog and, optionally, a second therapeutic agent such as anangiogenesis inhibitor. The instructions may be provided together with,or separately from, one or more of the therapeutic agents.

Assessing Properties of Compstatin and Compstatin Analogs

Any suitable method can be used for assessing any of the properties ofcompstatin or an analog or mimetic thereof. A number of in vitro assayscan be used. For example, ability of an agent to inhibit the classicalor alternative complement pathway may be assessed by measuringcomplement-mediated hemolysis of erythrocytes (e.g., antibody-sensitizedor unsensitized rabbit or sheep erythrocytes) by serum, e.g., humanserum, plasma, or a set of complement components in the presence orabsence of the agent. An agent inhibits complement if it decreaseshemolysis in this inhibition assay to a statistically significant degree(p<0.05).

The ability of an agent to bind to one or more complement component suchas C3 can be assessed using isothermal titration calorimetry or othermethods suitable for performing in liquid phase. In another embodiment,the ability of an agent to bind to a complement component is measuredusing an ELISA assay. For example, the wells of a microtiter plate arecoated with the agent. A compstatin analog or mimetic may befunctionalized in order to facilitate binding it to a plate. Forexample, the agent could be biotinylated, and a streptavidin-coatedplate is used. Complement component(s) are added to the wells. After aperiod of incubation the wells are washed, and bound complementcomponents are detected using antibodies to the complement component ofinterest. Other methods of use include surface plasmon resonance,equilibrium dialysis, etc.

Certain of the foregoing methods are described in U.S. Pat. No.6,319,897; PCT publication WO2004/026328 (PCT/US2003/029653), Morikis,D., et al., Biochem Soc Trans. 32(Pt 1):28-32, 2004, and Mallik, B., etal., J. Med. Chem., 274-286, 2005. Any of these methods or variantsthereof, or others known in the art, can be used. In one embodiment, theassay described in Example 4 or 5 is used.

Targeting Compstatin and Compstatin Analogs and Mimetics

The invention provides a composition comprising (i) compstatin or acomplement inhibiting analog thereof; and (ii) a binding moiety thatbinds to a component present in the eye of a subject at risk of orsuffering from a retinal disorder characterized by macular degeneration,choroidal neovascularization, or both, e.g, a macular degenerationrelated condition, diabetic retinopathy, or retinopathy of prematurity.The composition can be used to treat or prevent any of the foregoingdisorders. Preferably the binding moiety and the compstatin orcompstatin analog are linked. The linkage can be covalent or noncovalentand can be direct or indirect in various embodiments of the invention.The binding moiety can be, for example, an antibody or ligand, asdiscussed below. According to certain embodiments of the invention thecomponent is a cellular marker. In other embodiments of the inventionthe component is a drusen constituent. The cellular marker can be anymarker that is expressed on or at the surface of a cell, preferably anendothelial cell or retinal pigment epithelial cell. In certainembodiments of the invention the cellular marker is a cell type specificmarker.

In general, the component can be any molecule present on or at thesurface of a cell or noncellular molecular entity. By “on or at thesurface of the cell or noncellular molecular entity” is meant that thecomponent is accessible to molecules present in the extracellularenvironment so that it can be recognized and bound by the moiety. Thecomponent may be entirely extracellular. The component may be insertedinto the cell membrane. In certain embodiments of the invention thecomponent may be partly or entirely within the membrane, in which casethe entity must partially penetrate the membrane to gain access. Ingeneral, the component is not located in the cytoplasm of a cell. Aslong as a sufficient portion of the component is exposed or accessibleso that it can be recognized and bound, it will be said to be present onor at the surface. In preferred embodiments of the invention thecomponent is a cellular marker, e.g., a cell type specific marker. Wherethe target is a molecular entity other than a cell, the component can beany chemical entity present on or at the surface of the molecule that isrecognizable by an antibody or ligand.

A number of cellular markers that are expressed on or at the surface ofendothelial cells and can be used to target compstatin or an analogthereof to endothelial cells in the eye (e.g., in the choroidalvasculature) are disclosed in U.S. Ser. No. 10/923,940. Tissue factor(TF), a molecule involved in hemostasis, is a preferred marker. Briefly,tissue factor is a cell membrane-bound glycoprotein (MW 46 kDa) and amember of the class 2 cytokine receptor family. It is composed of ahydrophilic extracellular domain, a membrane-spanning hydrophobicdomain, and a cytoplasmic tail of 21 residues, including anon-disulfide-linked cysteine. Upon exposure to blood, perivascularcell-bound TF binds to factor VII (FVII), a vitamin K-dependent serineprotease. TF is expressed on endothelial cells lining the luminalsurface of various forms of pathological neovasculature, includingpathological vasculature associated with the exudative (wet) form ofage-related macular degeneration and diabetic retinopathy but typicallyis not expressed (or is expressed at a much lower level) in normalvasculature, thus providing a specific and accessible target. By linkinga compstatin or a compstatin analog to factor VII or a derivativethereof, the compstatin or analog is targeted to cells that express TF,e.g., endothelial cells in pathological neovasculature. Integrinalpha(v) beta(3) is another preferred marker.

A number of markers are expressed on or at the surface of retinalpigment epithelial cells. These include, but are not limited to, CD68antigen (Elner S G, Exp Eye Res. 1992 July; 55(1):21-8), claudin(Nishiyama K, et al., Anat Rec. 2002 Jul. 1; 267(3):196-203, the proteinencoded by the RPE65 gene (Nicoletti A., et al., Invest Ophthalmol V isSci. 1998 March; 39(3):637-44), CD45 and ICAM-1 (Limb, G A, et al., CurrEye Res. 1997 Oct.; 16(10):985-91). See also Chowers, I., et al.,Studies on retinal and retinal pigment epithelial gene expression,Novartis Found Symp. 2004; 255:131-45, 145-6, 177-8 for additionalexamples.

A large number of molecular components have been identified in drusen.Such components are suitable noncellular molecular entities to whichcompstatin or a compstatin analog can be targeted. These constituentsinclude α1-antichymotrypsin, α1-antitrypsin, Alzheimer amyloid βpeptide, advanced glycation end products, amyloid P component,apolipoproteins B and E, carbohydrate moieties recognized by variouslectins, cholesterol esters, clusterin, complement factors, clusterdifferentiation antigen, complement receptor 1, factor X, heparansulfate proteoglycan, human leukocyte antigen DR, immunoglobulin lightchains, major histocompatibility complex class II antigens, membranecofactor protein, peroxidized lipids, phospholipids and neutral lipids,tissue inhibitor of matrix metalloproeinases-3, transthyretin,ubiquitin, and vitronectin (Zarbin, M A, Arch Ophthalmol. 122:598-614,2004). A number of these components are also found in depositsassociated with a variety of different diseases includingatherosclerosis.

In certain preferred embodiments of the invention the binding moiety islinked to compstatin or a complement inhibiting analog thereof. In otherembodiments the binding moiety comprises a portion that binds to anothermolecule to which compstatin or an analog thereof is attached. Suitablebinding moieties include antibodies that specifically bind to a cellularmarker or noncellular molecular entity such as a drusen constituent andligands that specifically bind to a cellular marker or noncellularmolecular entity such as a drusen constituent. In general, the linkagebetween the binding moiety and the compstatin or a complement inhibitinganalog thereof can be covalent or noncovalent and can be direct orindirect in various embodiments of the invention. Similarly, a moietythat binds to a noncellular marker such as a drusen constituent may belinked to compstatin or a complement inhibiting analog thereof or toanother molecule to which compstatin or a complement inhibiting analogthereof is attached.

In those embodiments of the invention in which the binding moiety is anantibody, the antibody may be any immunoglobulin or a derivativethereof, which maintains binding ability, or any protein having abinding domain which is homologous or largely homologous to animmunoglobulin binding domain. Such proteins may be derived from naturalsources, or partly or wholly synthetically produced (e.g., usingrecombinant DNA techniques, chemical synthesis, etc.). The antibody canbe of any species, e.g., human, rodent, rabbit, goat, chicken, etc. Theantibody may be a member of any immunoglobulin class, including any ofthe human classes: IgG, IgM, IgA, IgD, and IgE. In various embodimentsof the invention the antibody may be a fragment of an antibody such asan Fab′, F(ab′)₂, scFv (single-chain variable) or other fragment thatretains an antigen binding site, or a recombinantly produced scFvfragment, including recombinantly produced fragments. See, e.g., Allen,T., Nature Reviews Cancer, Vol. 2, 750-765, 2002, and referencestherein. Monovalent, bivalent or multivalent antibodies can be used. Theantibody may be a chimeric or “humanized” antibody in which, forexample, a variable domain of rodent origin is fused to a constantdomain of human origin, thus retaining the specificity of the rodentantibody. It is noted that the domain of human origin need not originatedirectly from a human in the sense that it is first synthesized in ahuman being. Instead, “human” domains may be generated in rodents whosegenome incorporates human immunoglobulin genes. See, e.g., Vaughan, etal., (1998), Nature Biotechnology, 16: 535-539. The antibody may bepartially or completely humanized. An antibody may be polyclonal ormonoclonal, though for purposes of the present invention monoclonalantibodies are generally preferred. Preferably the antibody specificallybinds to its target on the cell surface, e.g., to a cell-type specificmarker. Methods for producing antibodies that specifically bind tovirtually any molecule of interest are known in the art. For example,monoclonal or polyclonal antibodies can be purified from naturalsources, e.g., from blood or ascites fluid of an animal that producesthe antibody (e.g., following immunization with the molecule or anantigenic fragment thereof) or can be produced recombinantly, in cellculture.

In certain embodiments of the invention it is preferable to use F(ab′)2or F(ab′) fragments rather than antibodies that contain an Fc portionsince the Fc portion may have a pro-inflammatory effect or cause otherundesirable effects. However, in certain embodiments of the invention itis preferred to use antibodies comprising an Fc domain. F(ab′)₂fragments can be generated, for example, through the use of anImmunopure F(ab′)₂ Preparation Kit (Pierce) in which the antibodies aredigested using immobilized pepsin and purified over an immobilizedProtein A column. The digestion conditions (such as temperature andduration) may be optimized by one of ordinary skill in the art to obtaina good yield of F(ab′)₂. The yield of F(ab′)₂ resulting from thedigestion can be monitored by standard protein gel electrophoresis.F(ab′) can be obtained by papain digestion of antibodies, or by reducingthe S—S bond in the F(ab′)₂.

In various embodiments of the invention an appropriate binding moiety towhich compstatin or a complement inhibiting analog thereof is linked canbe any molecule that specifically binds to a target molecule (e.g.,polypeptide or a portion thereof such as a carbohydrate moiety), througha mechanism other than an antigen-antibody interaction. Such a bindingmoiety is referred to as a “ligand”. For example, in various embodimentsof the invention a ligand can be a polypeptide, peptide, nucleic acid(e.g., DNA or RNA), carbohydrate, lipid or phospholipid, or smallmolecule (e.g., an organic compound, whether naturally-occurring orartificially created that has relatively low molecular weight and is nota protein, polypeptide, nucleic acid, or lipid, typically with amolecular weight of less than about 1500 g/mol and typically havingmultiple carbon-carbon bonds).

Ligands may be naturally occurring or synthesized, including moleculeswhose structure has been invented by man. Examples of ligands include,but are not limited to, hormones, growth factors, or neurotransmittersthat bind to particular receptors. For example, Factor VII is a ligandfor TF. Exemplary TF binding moieties are FVII, activated FVII (FVIIa),inactive FVIIa, antibodies that bind to tissue factor, engineeredpolypeptides, aptamers, and small molecules that bind to tissue factor.Inactive FVII or inactive FVIIa is a derivative of FVII or FVIIa that iscatalytically inactivated in the active site, e.g., by derivatizationwith an inhibitor. Many irreversible serine protease inhibitors, whichgenerally form covalent bonds with the protease active site, are knownin the art. Examples of suitable inhibitors include peptide halomethylketones, e.g., peptide chloromethyl ketones (see, Williams et al., J.Biol. Chem. 264:7536-7540, 1989 and U.S. Pat. No. 5,817,788). In someembodiments FVII or FVIIa activity is inhibited by substitution,deletion, and/or insertion of one or more amino acids in FVII.Generally, the substitution(s), insertion(s), and/or deletion(s) aremade at or adjacent to a catalytic site residue. In certain embodiments,the alteration(s) is a substitution or deletion of Ser344, Asp242,and/or His193. As mentioned above, TF binds to factor VII that isnormally present in the blood. Thus according to one embodiment of theinvention compstatin analog is linked to a TF binding moiety. Thebinding moiety binds to TF, present on endothelial cells in choroidalneovasculature, thereby providing an increased amount of the compstatinanalog at the cell surface and preventing additional complementactivation.

It will also be appreciated that fragments or variants of theabove-mentioned polypeptide ligands differing in sequence from theirnaturally occurring counterparts but retaining the ability to bind toendothelial cells or retinal pigment epithelial cells can also be used.In certain embodiments of the invention, a polypeptide ligand contains 5or fewer amino acid differences, 10 or fewer amino acid differences, 25or fewer amino acid differences, 50 or fewer amino acid differences, or100 or fewer amino acid differences with respect to its naturallyoccurring counterpart. In certain embodiments of the invention thenumber of amino acid differences between a naturally occurringpolypeptide ligand and a fragment or variant thereof for use in theinvention is 5% or less, 10% or less, or 25% or less of the total numberof amino acids in the naturally occurring polypeptide.

In certain embodiments of the invention a fragment or variant of anaturally occurring polypeptide ligand is at least 70% identical, atleast 80% identical, at least 90% identical, at least 95% identical,over an amino acid portion that constitutes at least 10%, at least 20%,at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, atleast 80%, or at least 90%, or 100% of the length of the naturallyoccurring counterpart. For example, variant that exhibits at least 50%,at least 60%, at least 70%, at least 80%, at least 90%, or greatersequence identity, over the relevant portion of the sequence could beused, wherein % identity is determined as described above. The aminoacid portion is preferably at least 20 amino acids in length, morepreferably at least 50 amino acids in length. Alternately, a fragment orvariant can display significant or, preferably, substantial homology toa naturally occurring counterpart. Generally a fragment or variant of anaturally occurring polypeptide ligand possesses sufficient structuralsimilarity to its naturally occurring counterpart that it is recognizedby an antibody (e.g., a polyclonal or monoclonal antibody) thatrecognizes the naturally occurring counterpart. Peptide ligands can beidentified using phage display (Arap W, et al, Nature Medicine8(2):121-7, 2002); Zurita A J, et al., J Control Release, 91(1-2):183-6,2003; Pasqualini, R. & Ruoslahti, E. Nature 380, 364-366, 1996;Pasqualini, R., et al., Trends Mol. Med. 8, 563-571, 2002).

In certain embodiments of the invention the ligand is an aptamer thatbinds to a cell type specific marker. In general, an aptamer is anoligonucleotide (e.g., DNA or RNA or) that binds to a particularprotein. Aptamers are typically derived from an in vitro evolutionprocess called SELEX, and methods for obtaining aptamers specific for aprotein of interest are known in the art. See, e.g., Brody E N, Gold L.J Biotechnol. 2000 March; 74(1):5-13.

Small molecules can also be used as ligands. Methods for identifyingsuch ligands are known in the art. For example in vitro screening ofsmall molecule libraries, including combinatorial libraries, andcomputer-based screening, e.g., to identify small organic compounds thatbind to concave surfaces (pockets) of proteins, can identify smallmolecule ligands for numerous proteins of interest (Huang, Z., Pharm. &Ther. 86: 201-215, 2000).

In certain embodiments of the invention binding moieties are notproteins or molecules that are typically used as carriers and conjugatedto antigens for the purpose of raising antibodies. Examples are carrierproteins or molecules such as bovine serum albumin, keyhole limpethemocyanin, bovine gamma globulin, and diphtheria toxin. In certainembodiments of the invention the cell binding moiety is not an Fcportion of an immunoglobulin molecule.

Methods for covalently or noncovalently linking a compstatin analog to abinding moiety are known in the art and are described in U.S. Ser. No.10/923,940. General methods for conjugation and cross-linking aredescribed in “Cross-Linking”, Pierce Chemical Technical Library,available at the Web site having URL www. followed immediatelybypiercenet.com and originally published in the 1994-95 Pierce Catalogand references cited therein, in Wong S S, Chemistry of ProteinConjugation and Crosslinking, CRC Press Publishers, Boca Raton, 1991;and G. T. Hermanson, supra. See also, Allen, T. M., Nature ReviewsCancer, 2, 750-763, 2002, which describes methods of making targetedtherapeutic agents. For example, according to certain embodiments of theinvention a bifunctional crosslinking reagent is used to couple acompstatin analog with an antibody or ligand. In general, bifunctionalcrosslinking reagents contain two reactive groups, thereby providing ameans of covalently linking two target groups. The reactive groups in achemical crosslinking reagent typically belong to various classesincluding succinimidyl esters, maleimides, pyridyldisulfides, andiodoacetamides. Bifunctional chelating agents may also be used.

Alternately, the compstatin analog and the moiety can be produced as afusion protein. Thus the invention provides a fusion protein comprising:(i) a first domain comprising a compstatin analog; and (ii) a seconddomain comprising a binding moiety that binds to a cellular marker ornoncellular molecular entity present in the eye of a subject sufferingfrom or at risk of a macular degeneration related condition or CNV. Thefirst domain may be at the N or C terminus of the fusion protein. Thefusion protein may contain one or more additional domains at either theN or C terminus or between the first and second domains. The fusionprotein can contain multiple regions having the sequence of thecompstatin analog, e.g., the fusion protein can comprise a concatamer ofthe compstatin analog. Optionally the different compstatin analog unitsare separated by a spacer, which may comprise a cleavage site for anenzyme (e.g., a protease) or chemical such as hydrazine. Also providedare nucleic acids encoding the fusion protein, expression vectorscomprising the nucleic acid, host cells that contain the expressionvector, and transgenic animals and plants containing the nucleic acid intheir genome.

Targeted versions of a compstatin analog, and novel compstatin analogsand mimetics provided herein can be used for treatment of a number ofconditions other than macular degeneration related conditions, diabeticretinopathy, RNV, CNV, ocular inflammation, etc. Such methods oftreatment are an aspect of this invention. For such purposes the bindingmoiety need not bind to a site in the eye. In general, the bindingmoiety is selected to target the complement inhibiting protein to anysite in the body at which complement inhibition is desired. For example,the compounds can be used to treat atherosclerosis, Alzheimer's disease,CNS injury (including spinal cord injury), transplant rejection, or anyother disease in which complement activation plays a role (e.g., certainforms of glomerulonephritis, certain inflammatory conditions), etc. Theycan be used to prevent complement activation during cardiac bypasssurgery or ischemia/reperfusion in myocardial infarction or stroke. Inone embodiment, a compstatin analog or mimetic is used to treat chronicpain. Atherosclerotic plaques, organ transplants (e.g., xenotransplants,allotransplants, etc.) may be targeted. The targeted compositions canalso be used in vitro, e.g., to treat platelets (which are consideredcells for purposes of the invention) or other blood preparations inorder to inhibit complement, or to treat organs prior totransplantation. Appropriate binding moieties, e.g., cell bindingmoieties or moieties that bind to a component in an atheroscleroticplaque, an Alzheimer's disease plaque (e.g., β-amyloid), etc. are usedto target the compstatin or a complement inhibiting analog thereof tothe plaque. A Gal (1,3-Gal) epitope on the surface of a transplantedorgan can be targeted.

Additional Modifications

Compstatin or an analog thereof, optionally linked to a binding moiety,can be modified by addition of a molecule such as polyethylene glycol(PEG) or similar molecules to stabilize the compound, reduce itsimmunogenicity, increase its lifetime in the body, increase or decreaseits solubility, and/or increase its resistance to degradation. Methodsfor pegylation are well known in the art (Veronese, F. M. & Harris, Adv.Drug Deliv. Rev. 54, 453-456, 2002; Davis, F. F., Adv. Drug Deliv. Rev.54, 457-458 (2002; Hinds, K. D. & Kim, S. W. Adv. Drug Deliv. Rev. 54,505-530 (2002; Roberts, M. J., Bentley, M. D. & Harris, J. M. Adv. DrugDeliv. Rev. 54, 459-476 (2002; Wang, Y. S. et al. Adv. Drug Deliv. Rev.54, 547-570, 2002). A wide variety of polymers such as PEGs and modifiedPEGs, including derivatized PEGs to which polypeptides can convenientlybe attached are described in Nektar Advanced Pegylation 2005-2006Product Catalog, Nektar Therapeutics, San Carlos, Calif., which alsoprovides details of appropriate conjugation procedures. In anotherembodiment compstatin or a compstatin analog is fused to the Fc domainof an immunoglobulin or a portion thereof. Thus in some embodimentscompstatin or a complement inhibiting analog thereof is modified withone or more polypeptide or non-polypeptide components, e.g., thecompstatin or analog is pegylated or conjugated to another moiety. Insome embodiments the component is not the Fc domain of an immunoglobulinor a portion thereof. Compstatin and/or a compstatin analog can beprovided as multimers or as part of a supramolecular complex, which caninclude either a single molecular species or multiple different species(e.g., multiple different analogs).

The invention provides a multivalent compound comprising a plurality ofcompstatin analog moieties covalently or noncovalently linked to apolymeric backbone or scaffold. The compstatin analog moieties may bethe same or different compstatin analog. The invention further providesa compstatin analog comprising a reactive functional group or comprisinga linker comprising a reactive functional group, wherein the reactivefunctional group facilitates the attachment of the compstatin analog tothe polymeric backbone. The compstatin analog can be any of thecompstatin analogs described herein. It will be appreciated thatfollowing attachment to the polymeric backbone, the structure of thecompstatin analog moiety will differ slightly from that of thecompstatin analogs described herein. For example, a compstatin analogmolecule comprising an amine (NH₂) group, represented as NH₂—R¹, mayreact with a moiety comprising a carboxylic acid (COOH), represented asR²—(C══O)OH to form a conjugate having formula R²—(C══O)—NH—R¹, in whichone of the hydrogens present in the compstatin analog is no longerpresent and a new covalent bond (C—N) has been formed. Thus the term“compstatin analog moiety” includes molecules having the precise formulaof a compstatin analog as described herein as well as molecularstructures in which a functional group of a compstatin analog hasreacted with a second functional group, which typically entails loss ofat least one atom or group of atoms that was present in the compstatinanalog molecule prior to the reaction and formation of a new covalentbond. The new covalent bond is formed between an atom that waspreviously attached to one of the atoms that is lost from the compstatinanalog and an atom to which the compstatin analog becomes attached.

The compstatin analog moieties can be identical or different. In certainembodiments of the invention the multivalent compound comprises multipleinstances, or copies, of a single compstatin analog moiety. In otherembodiments of the invention the multivalent compound comprises one ormore instances of each of two of more non-identical compstatin analogmoieties, e.g., 3, 4, 5, or more different compstatin analog moieties.In certain embodiments of the invention the number of compstatin analogmoieties (“n”) is between 2 and 6. In other embodiments of the inventionn is between 7 and 20. In other embodiments of the invention n isbetween 20 and 100. In other embodiments n is between 100 and 1,000. Inother embodiments of the invention n is between 1,000 and 10,000. Inother embodiments n is between 10,000 and 50,000. In other embodiments nis between 50,000 and 100,000. In other embodiments n is between 100,000and 1,000,000.

The compstatin analog moieties may be attached directly to the polymericscaffold or may be attached via a linking moiety that connects thecompstatin analog moiety to the polymeric scaffold. The linking moietymay be attached to a single compstatin analog moiety and to thepolymeric scaffold. Alternately, a linking moiety may have multiplecompstatin analog moieties joined thereto so that the linking moietyattaches multiple compstatin analog moieties to the polymeric scaffold.

In one embodiment, the compstatin analog comprises an amino acid havinga side chain comprising a primary or secondary amine, e.g., a Lysresidue. For example, a Lys residue, or a sequence comprising a Lysresidue, is added at the C-terminus of the compstatin analog. In oneembodiment, the Lys residue is separated from the cyclic portion of thecompstatin analog by a rigid or flexible spacer. The spacer may, forexample, be a substituted or unsubstitued, saturated or unsaturatedalkyl chain. The length of the alkyl chain may be, e.g., between 2 and20 carbon atoms. In other embodiments the spacer is a peptide. Thepeptide spacer may be, e.g., between 1 and 20 amino acids in length,e.g., between 4 and 20 amino acids in length. Suitable spacers compriseor consist of multiple Gly residues, Ser residues, or both.

Any of a variety of polymeric backbones or scaffolds could be used. Forexample, the polymeric backbone or scaffold may be a polyamide,polysaccharide, polyanhydride, polyacrylamide, polymethacrylated,polypeptide, polyethylene oxide, or dendrimer. Suitable methods andpolymeric backbones are described, e.g., in WO98/46270 (PCT/US98/07171)or WO98/47002 (PCT/US98/06963). In one embodiment, the polymericbackbone or scaffold comprises multiple reactive functional groups, suchas carboxylic acids, anhydride, or succinimide groups. The polymericbackbone or scaffold is reacted with the compstatin analogs. In oneembodiment, the compstatin analog comprises any of a number of differentreactive functional groups, such as carboxylic acids, anhydride, orsuccinimide groups, which are reacted with appropriate groups on thepolymeric backbone. Alternately, monomeric units that could be joined toone another to form a polymeric backbone or scaffold are first reactedwith the compstatin analogs and the resulting monomers are polymerized.In another embodiment, short chains are prepolymerized, functionalized,and then a mixture of short chains of different composition areassembled into longer polymers.

Pharmaceutical Compositions and Delivery Vehicles and Methods

Suitable preparations, e.g., substantially pure preparations of thecompstatin analog or mimetic, or any of the compounds described above,may be combined with pharmaceutically acceptable carriers, diluents,solvents, etc., to produce an appropriate pharmaceutical composition.Such pharmaceutical compositions are an aspect of the invention. Theinvention further provides a pharmaceutically acceptable compositioncomprising (i) a compstatin analog linked to a moiety that binds to acomponent present on or at the surface of a cell or noncellularmolecular entity; and (ii) a pharmaceutically acceptable carrier orvehicle. The moiety may be an antibody or ligand. The component may be amarker such as a cell type specific marker for RPE or endothelial cells,a drusen constituent, etc.

In certain embodiments of the invention the pharmaceutical compositiondetectably inhibits neovascularization in an eye, followingadministration to a subject. In other words, administration of thecompound measurably reduces neovascularization relative to the expectedlevel in the absence of the composition. In certain embodiments of theinvention the pharmaceutical composition detectably inhibits developmentor progression of geographic atrophy and/or drusen formation in an eye,following administration to a subject. In other words, administration ofthe compound measurably reduces development or progression of geographicatrophy and/or drusen formation relative to the expected level in theabsence of the composition. In certain embodiments the compositioninhibits increase in retinal thickness (e.g., as measured by OCT)associated with the disease (e.g., the wet type of ARMD). In certainembodiments of the invention the pharmaceutical composition detectablyinhibits vision loss in an eye, following administration to a subject.In other words, administration of the compound measurably reduces visionloss relative to the expected level in the absence of the composition.In certain embodiments of the invention the pharmaceutical compositiondetectably inhibits inflammation in an eye, following administration toa subject. In other words, administration of the compound measurablyreduces inflammation relative to the expected level in the absence ofthe composition. It is to be understood that the pharmaceuticalcompositions of the invention, when administered to a subject, arepreferably administered for a time and in an amount sufficient to treator prevent the disease or condition for whose treatment or preventionthey are administered. A useful pharmaceutical composition may provideone or more than one of the afore-mentioned beneficial effects.

Further of use in the invention are pharmaceutically acceptablecompositions comprising a pharmaceutically acceptable derivative (e.g.,a prodrug) of compstatin or a complement inhibiting analog thereof, bywhich is meant any non-toxic salt, ester, salt of an ester or otherderivative of a compound of this invention that, upon administration toa recipient, is capable of providing, either directly or indirectly, acompound of this invention or an inhibitorily active metabolite orresidue thereof. As used herein, the term “inhibitorily activemetabolite or residue thereof” means that a metabolite or residuethereof is also able to detectably inhibit complement, e.g., inhibitcomplement activation.

In various embodiments of the invention an effective amount of thepharmaceutical composition is administered to a subject by any suitableroute of administration including, but not limited to, intravenous,intramuscular, by inhalation, by catheter, intraocularly, orally,rectally, intradermally, by application to the skin, by eyedrops, etc.When a composition of the invention is used to treat an ophthalmiccondition it will be appreciated that administration to the eye to or inthe vicinity of the eye, may be preferred. In certain embodiments of theinvention the intravenous route is used. For example, a compstatinanalog may be administered in a solid implant, or in a microparticle ornanoparticle formulation, whereby it is protected from clearance and/ordegradation in the bloodstream.

Inventive compositions may be formulated for delivery by any availableroute including, but not limited to parenteral, oral, by inhalation tothe lungs, nasal, bronchial, ophthalmic, transdermal (topical),transmucosal, rectal, and vaginal routes. The term “parenteral” as usedherein includes subcutaneous, intravenous, intramuscular,intra-articular, intra-synovial, intrasternal, intrathecal,intrahepatic, intralesional and intracranial injection or infusiontechniques. Preferably, the compositions are administered either locallyto the eye or intravenously.

The term “pharmaceutically acceptable carrier or vehicle” refers to anon-toxic carrier or vehicle that does not destroy the pharmacologicalactivity of the compound with which it is formulated. Pharmaceuticallyacceptable carriers or vehicles that may be used in the compositions ofthis invention include, but are not limited to, water, physiologicalsaline, and the like.

The composition may include other components as appropriate for theformulation desired, e.g., buffer substances such as phosphates,glycine, sorbic acid, potassium sorbate, partial glyceride mixtures ofsaturated vegetable fatty acids, salts or electrolytes, such asprotamine sulfate, disodium hydrogen phosphate, potassium hydrogenphosphate, sodium chloride, zinc salts, colloidal silica, magnesiumtrisilicate, polyvinyl pyrrolidone, cellulose-based substances,polyethylene glycol, sodium carboxymethylcellulose, polyacrylates,waxes, polyethylene-polyoxypropylene-block polymers, polyethylene glycoland wool fat. Solvents, dispersion media, coatings, antibacterial andantifungal agents, isotonic and absorption delaying agents, and thelike, compatible with pharmaceutical administration may be included.Supplementary active compounds, e.g., compounds independently activeagainst the disease or clinical condition to be treated, or compoundsthat enhance activity of a compound, can also be incorporated into thecompositions.

Pharmaceutically acceptable salts of the compounds of this inventioninclude those derived from pharmaceutically acceptable inorganic andorganic acids and bases. Examples of suitable acid salts includeacetate, adipate, alginate, aspartate, benzoate, benzenesulfonate,bisulfate, butyrate, citrate, camphorate, camphorsulfonate,cyclopentanepropionate, digluconate, dodecylsulfate, ethanesulfonate,formate, fumarate, glucoheptanoate, glycerophosphate, glycolate,hemisulfate, heptanoate, hexanoate, hydrochloride, hydrobromide,hydroiodide, 2-hydroxyethanesulfonate, lactate, maleate, malonate,methanesulfonate, 2-naphthalenesulfonate, nicotinate, nitrate, oxalate,palmoate, pectinate, persulfate, 3-phenylpropionate, phosphate, picrate,pivalate, propionate, salicylate, succinate, sulfate, tartrate,thiocyanate, tosylate and undecanoate. Other acids, such as oxalic,while not in themselves pharmaceutically acceptable, may be employed inthe preparation of salts useful as intermediates in obtaining thecompounds of the invention and their pharmaceutically acceptable acidaddition salts.

Salts derived from appropriate bases include alkali metal (e.g., sodiumand potassium), alkaline earth metal (e.g., magnesium), ammonium and N⁺(C1-4 alkyl)4 salts. This invention also envisions the quaternization ofany basic nitrogen-containing groups of the compounds disclosed herein.Water or oil-soluble or dispersible products may be obtained by suchquaternization.

A pharmaceutical composition is formulated to be compatible with itsintended route of administration. Solutions or suspensions used forparenteral (e.g., intravenous), intramuscular, intradermal, orsubcutaneous application can include the following components: a sterilediluent such as water for injection, saline solution, dimethyl sulfoxide(DMSO), fixed oils, polyethylene glycols, glycerine, propylene glycol orother synthetic solvents; antibacterial agents such as benzyl alcohol ormethyl parabens; antioxidants such as ascorbic acid or sodium bisulfite;chelating agents such as ethylenediaminetetraacetic acid; buffers suchas acetates, citrates or phosphates and agents for the adjustment oftonicity such as sodium chloride or dextrose. pH can be adjusted withacids or bases, such as hydrochloric acid or sodium hydroxide. Theparenteral preparation can be enclosed in ampoules, disposable syringesor multiple dose vials made of glass or plastic.

Pharmaceutical compositions suitable for injectable use typicallyinclude sterile aqueous solutions (where water soluble) or dispersionsand sterile powders for the extemporaneous preparation of sterileinjectable solutions or dispersion. For intravenous administration,suitable carriers include physiological saline, bacteriostatic water,Cremophor EL™ (BASF, Parsippany, N.J.), phosphate buffered saline (PBS),or Ringer's solution.

Sterile, fixed oils are conventionally employed as a solvent orsuspending medium. For this purpose, any bland fixed oil may be employedincluding synthetic mono- or di-glycerides. Fatty acids, such as oleicacid and its glyceride derivatives are useful in the preparation ofinjectables, as are natural pharmaceutically-acceptable oils, such asolive oil or castor oil, especially in their polyoxyethylated versions.These oil solutions or suspensions may also contain a long-chain alcoholdiluent or dispersant, such as carboxymethyl cellulose or similardispersing agents that are commonly used in the formulation ofpharmaceutically acceptable dosage forms including emulsions andsuspensions. Other commonly used surfactants, such as Tweens, Spans andother emulsifying agents or bioavailability enhancers which are commonlyused in the manufacture of pharmaceutically acceptable solid, liquid, orother dosage forms may also be used for the purposes of formulation.

In general, the composition should be sterile, if possible, and shouldbe fluid so that easy syringability exists.

Preferred pharmaceutical formulations are stable under the conditions ofmanufacture and storage and may be preserved against the contaminatingaction of microorganisms such as bacteria and fungi. In general, therelevant carrier can be a solvent or dispersion medium containing, forexample, water, ethanol, polyol (for example, glycerol, propyleneglycol, and liquid polyetheylene glycol, and the like), and suitablemixtures thereof. The proper fluidity can be maintained, for example, bythe use of a coating such as lecithin, by the maintenance of therequired particle size in the case of dispersion and by the use ofsurfactants. Prevention of the action of microorganisms can be achievedby various antibacterial and antifungal agents, for example, parabens,chlorobutanol, phenol, ascorbic acid, thimerosal, and the like. In manycases, it will be preferable to include isotonic agents, for example,sugars, polyalcohols such as manitol, sorbitol, sodium chloride in thecomposition. Prolonged absorption of injectable compositions can bebrought about by including in the composition an agent which delaysabsorption, for example, aluminum monostearate and gelatin. Prolongedabsorption of oral compositions can be achieved by various meansincluding encapsulation.

Sterile injectable solutions can be prepared by incorporating the activecompound in the required amount in an appropriate solvent with one or acombination of ingredients enumerated above, as required, followed byfiltered sterilization. Preferably solutions for injection are free ofendotoxin. Generally, dispersions are prepared by incorporating theactive compound into a sterile vehicle which contains a basic dispersionmedium and the required other ingredients from those enumerated above.In the case of sterile powders for the preparation of sterile injectablesolutions, the preferred methods of preparation are vacuum drying andfreeze-drying which yields a powder of the active ingredient plus anyadditional desired ingredient from a previously sterile-filteredsolution thereof.

Oral compositions generally include an inert diluent or an ediblecarrier. For the purpose of oral therapeutic administration, the activecompound can be incorporated with excipients and used in the form oftablets, troches, or capsules, e.g., gelatin capsules. Oral compositionscan also be prepared using a fluid carrier for use as a mouthwash.Pharmaceutically compatible binding agents, and/or adjuvant materialscan be included as part of the composition. The tablets, pills,capsules, troches and the like can contain any of the followingingredients, or compounds of a similar nature: a binder such asmicrocrystalline cellulose, gum tragacanth or gelatin; an excipient suchas starch or lactose, a disintegrating agent such as alginic acid,Primogel, or corn starch; a lubricant such as magnesium stearate orSterotes; a glidant such as colloidal silicon dioxide; a sweeteningagent such as sucrose or saccharin; or a flavoring agent such aspeppermint, methyl salicylate, or orange flavoring. Formulations fororal delivery may advantageously incorporate agents to improve stabilitywithin the gastrointestinal tract and/or to enhance absorption.

For administration by inhalation, the inventive compositions arepreferably delivered in the form of an aerosol spray from a pressuredcontainer or dispenser which contains a suitable propellant, e.g., a gassuch as carbon dioxide, or a nebulizer. Liquid or dry aerosol (e.g., drypowders, large porous particles, etc.) can be used. The presentinvention also contemplates delivery of compositions using a nasalspray.

For topical applications, the pharmaceutically acceptable compositionsmay be formulated in a suitable ointment containing the active componentsuspended or dissolved in one or more carriers. Carriers for topicaladministration of the compounds of this invention include, but are notlimited to, mineral oil, liquid petrolatum, white petrolatum, propyleneglycol, polyoxyethylene, polyoxypropylene compound, emulsifying wax andwater. Alternatively, the pharmaceutically acceptable compositions canbe formulated in a suitable lotion or cream containing the activecomponents suspended or dissolved in one or more pharmaceuticallyacceptable carriers. Suitable carriers include, but are not limited to,mineral oil, sorbitan monostearate, polysorbate 60, cetyl esters wax,cetearyl alcohol, octyldodecanol, benzyl alcohol and water.

For local delivery to the eye, the pharmaceutically acceptablecompositions may be formulated in isotonic, pH adjusted sterile salineor water, either with or without a preservative such as benzylalkoniumchloride. Alternatively, for ophthalmic uses, the pharmaceuticallyacceptable compositions may be formulated in an ointment such aspetrolatum or as eyedrops.

Methods of local administration to the eye include, e.g., choroidalinjection, transscleral injection or placing a scleral patch, selectivearterial catheterization, eyedrops or eye ointments, intraocularadministration including transretinal, subconjunctival bulbar,intravitreous injection, suprachoroidal injection, subtenon injection,scleral pocket and scleral cutdown injection, by osmotic pump, etc. Theagent can also be alternatively administered intravascularly, such asintravenously (IV) or intraarterially. In choroidal injection andscleral patching, the clinician uses a local approach to the eye afterinitiation of appropriate anesthesia, including painkillers andophthalmoplegics. A needle containing the therapeutic compound isdirected into the subject's choroid or sclera and inserted under sterileconditions. When the needle is properly positioned the compound isinjected into either or both of the choroid or sclera. When using eitherof these methods, the clinician can choose a sustained release or longeracting formulation. Thus, the procedure can be repeated only everyseveral months or several years, depending on the subject's tolerance ofthe treatment and response.

Intraocular administration of drugs intended for treatment of maculardegeneration and other intraocular conditions is well known in the art.See, e.g., U.S. Pat. Nos. 5,632,984 and 5,770,589. U.S. Pat. No.6,378,526 provides methods for intrascleral injection of a therapeuticor diagnostic material at a location overlying the retina, which providea minimally invasive technique for delivering the agent to the posteriorsegment of the eye.

In certain embodiments of the invention a composition is delivered tothe vicinity of the eye, e.g., in close proximity to the posteriorsegment of the eye. The “vicinity of the eye” refers to locations withinthe orbit, which is the cavity within the skull in which the eye and itsappendages are situated. Typically the compositions would be deliveredclose to their intended target within the eye, e.g., close to (withinseveral millimeters of) the portion of the sclera that overlies theposterior segment of the eye, or immediately adjacent to the exteriorsurface of the sclera.

A number of polymeric delivery vehicles for providing controlled releasehave been used in an ocular context and can be used to administer thecompositions of the invention. Various polymers, e.g., biocompatiblepolymers, which may be biodegradable, can be used. For example, U.S.Pat. No. 6,692,759 describes methods for making an implantable devicefor providing controlled release of therapeutic agents in the eye. Otheruseful polymers and delivery systems for ocular administration of atherapeutic agent have been described. The active agent may be releasedas the polymer degrades. Polymers that have been used for drug deliveryinclude, but are not limited to, poly(lactic-co-glycolic acid),polyanhydrides, ethylene vinyl acetate, polyglycolic acid, chitosan,polyorthoesters, polyethers, polylactic acid, and poly (beta aminoesters). Peptides, proteins such as collagen and albumin, and dendrimers(e.g., PAMAM dendrimers) have also been used. Any of these can be usedin various embodiments of the invention.

Poly(ortho esters) have been introduced into the eye and demonstratedfavorable properties for sustained release ocular drug delivery(Einmahl, S., Invest. Ophthalmol. Vis. Sci., 43(5), 2002). Polylactideparticles have been used to target an agent to the retina and RPEfollowing intravitreous injection of a suspension of such particles(Bourges, J-L, et al, Invest. Ophthalmol. Vis. Sci., 44(8), 2003). Amacroscopic implantable device suitable for introduction into theposterior or anterior segment of the eye is referred to herein as anocular implant (Jaffe, G., Invest. Ophthalmol. Vis. Sci., 41(11), 2000;Jaffe, G., Ophthalmology). The invention provides an ocular implantcomprising a compstatin analog, e.g., in an amount effective to treat aneye disorder such as ARMD. Such devices may be macroscopic implantscomprising the agent or may be comprised of a plurality of nanoparticlesor microparticles impregnated with or encapsulating the agent. In oneembodiment, the ocular implant is any ocular implant known in the art.Exemplary implants and methods for manufacture thereof are described,e.g., in provisional patent application entitled “Injectable CombinationTherapy for Eye Disorders” (U.S. Ser. No. 60/760,974) filed Jan. 19,2006. Other implants known in the art can also be used. In certainembodiments the implant comprises between 100 and 2000 μg of acompstatin analog, e.g., between 100 and 1000 μg, e.g., between 100 and500 μg.

Methods for making microparticles and nanoparticles are known in theart. Generally, a microparticle will have a diameter of 500 microns orless, e.g., between 50 and 500 microns, between 20 and 50 microns,between 1 and 20 microns, between 1 and 10 microns, and a nanoparticlewill have a diameter of less than 1 micron. Preferably the device isimplanted into the space occupied by the vitreous humor. The ocularimplant may comprise a polymeric matrix. The invention also providesperiocular implants, which are macroscopic implantable device suitablefor introduction in the vicinity of the eye, e.g., in close proximity tothe eye. In certain embodiments the periocular implant is made ofsimilar materials to those described above.

Cells that express compstatin or a complement inhibiting analog thereofcan be implanted into the eye. U.S. Pat. No. 6,436,427 provides a methodfor delivering biologically active molecules to the eye by implantingbiocompatible capsules containing a cellular source of the biologicallyactive molecule.

The pharmaceutically acceptable compositions of this invention may alsobe administered by nasal aerosol or inhalation. Such compositions areprepared according to techniques well-known in the art of pharmaceuticalformulation and may be prepared as solutions in saline, employing benzylalcohol or other suitable preservatives, absorption promoters to enhancebioavailability, fluorocarbons, and/or other conventional solubilizingor dispersing agents.

Systemic administration can also be by transmucosal or transdermalmeans. For transmucosal or transdermal administration, penetrantsappropriate to the barrier to be permeated are used in the formulation.Such penetrants are generally known in the art, and include, forexample, for transmucosal administration, detergents, bile salts, andfusidic acid derivatives. Transmucosal administration can beaccomplished through the use of nasal sprays or suppositories. Fortransdermal administration, the active compounds are formulated intoointments, salves, gels, or creams as generally known in the art.

The compounds can also be prepared in the form of suppositories (e.g.,with conventional suppository bases such as cocoa butter and otherglycerides) or retention enemas for rectal delivery.

In addition to the agents described above, in certain embodiments of theinvention, the active compounds are prepared with carriers that willprotect the compound against rapid elimination from the body, such as acontrolled release formulation, including implants and microencapsulateddelivery systems. Biodegradable, biocompatible polymers can be used,such as ethylene vinyl acetate, polyanhydrides, polyglycolic acid,collagen, polyorthoesters, polyethers, and polylactic acid. Methods forpreparation of such formulations will be apparent to those skilled inthe art. Certain of the materials can also be obtained commercially fromAlza Corporation and Nova Pharmaceuticals, Inc. Liposomal suspensionscan also be used as pharmaceutically acceptable carriers. These can beprepared according to methods known to those skilled in the art, forexample, as described in U.S. Pat. No. 4,522,811 and other referenceslisted herein. Liposomes, including targeted liposomes (e.g., antibodytargeted liposomes) and pegylated liposomes have been described (HansenC B, et al., Biochim Biophys Acta. 1239(2):133-44, 1995; Torchilin V P,et al., Biochim Biophys Acta, 1511(2):397-411, 2001; Ishida T, et al.,FEBS Lett. 460(1):129-33, 1999). One of ordinary skill in the art willappreciate that the materials and methods selected for preparation of acontrolled release formulation, implant, etc., should be such as toretain activity of the compound. For example, it may be desirable toavoid excessive heating of polypeptides, which could lead todenaturation and loss of activity.

The invention also encompasses gene therapy, in which a nucleic acidthat encodes compstatin or a complement inhibiting analog thereof inoperable association with expression control signals, e.g., regulatoryelements such as a promoter, terminator, polyadenylation signal, etc.,sufficient to direct expression of the fragment or variant is introducedinto a subject. The nucleic acid may encode a fusion protein comprisingcompstatin or a complement inhibiting analog thereof. Nucleic acids canbe introduced into a subject by any of a number of methods. Forinstance, a pharmaceutical preparation of a nucleic acid therapeutic canbe introduced systemically, e.g., by intravenous injection. Expressionof the polypeptide in particular target cells may result fromspecificity of transfection provided by the vector, cell-type ortissue-type expression due to the transcriptional regulatory sequencescontrolling expression of the gene, or a combination thereof.Alternatively, initial delivery of the nucleic acid can be more limited.For example, the vector can be locally introduced into the eye using anyof the methods described above for ocular administration.

A pharmaceutical composition comprising a nucleic acid therapeutic ofthe invention can consist essentially of the nucleic acid or a genetherapy vector comprising in an acceptable diluent, or can comprise aslow release matrix in which the nucleic acid or gene therapy vector isencapsulated or embedded. The gene therapy vector can be a plasmid,virus, or other vector. Alternatively, the pharmaceutical compositioncan comprise one or more cells which produce a therapeutic nucleic acidor polypeptide such as compstatin or a complement inhibiting analogthereof. Preferably such cells secrete the peptide into theextracellular space or bloodstream.

Viral vectors that have been used for gene therapy protocols include,but are not limited to, retroviruses, lentiviruses, other RNA virusessuch as poliovirus or Sindbis virus, adenovirus, adeno-associated virus,herpes viruses, SV 40, vaccinia and other DNA viruses.Replication-defective murine retroviral or lentiviral vectors are widelyutilized gene transfer vectors. Chemical methods of gene therapy involvecarrier-mediated gene transfer through the use of fusogenic lipidvesicles such as liposomes or other vesicles for membrane fusion. Acarrier harboring a nucleic acid of interest can be convenientlyintroduced into the eye or into body fluids or the bloodstream. Thecarrier can be site specifically directed to the target organ or tissuein the body. Cell or organ-specific DNA-carrying liposomes, for example,can be developed and the foreign nucleic acid carried by the liposomeabsorbed by those specific cells. Carrier mediated gene transfer mayalso involve the use of lipid-based compounds which are not liposomes.For example, lipofectins and cytofectins are lipid-based compoundscontaining positive ions that bind to negatively charged nucleic acidsand form a complex that can ferry the nucleic acid across a cellmembrane. Cationic polymers are known to spontaneously bind to andcondense nucleic acids such as DNA into nanoparticles. For example,naturally occurring proteins, peptides, or derivatives thereof have beenused. Synthetic cationic polymers such as polyethylenimine (PEI),polylysine (PLL) etc., are also known to condense DNA and are usefuldelivery vehicles. Dendrimers can also be used.

Many of the useful polymers contain both chargeable amino groups, toallow for ionic interaction with the negatively charged DNA phosphate,and a degradable region, such as a hydrolyzable ester linkage. Examplesof these include poly(alpha-(4-aminobutyl)-L-glycolic acid), networkpoly(amino ester), and poly (beta-amino esters). These complexationagents can protect DNA against degradation, e.g., by nucleases, serumcomponents, etc., and create a less negative surface charge, which mayfacilitate passage through hydrophobic membranes (e.g., cytoplasmic,lysosomal, endosomal, nuclear) of the cell. Certain complexation agentsfacilitate intracellular trafficking events such as endosomal escape,cytoplasmic transport, and nuclear entry, and can dissociate from thenucleic acid. It has been proposed that such agents may act as a “protonsponge” within the endosome.

It is typically advantageous to formulate oral or parenteralcompositions in dosage unit form for ease of administration anduniformity of dosage. Dosage unit form as used herein refers tophysically discrete units suited as unitary dosages for the subject tobe treated; each unit containing a predetermined quantity of activecompound calculated to produce the desired therapeutic effect inassociation with the required pharmaceutical carrier.

Toxicity and therapeutic efficacy of such compounds can be determined bystandard pharmaceutical procedures in cell cultures or experimentalanimals, e.g., for determining the LD₅₀ (the dose lethal to 50% of thepopulation) and the ED₅₀ (the dose therapeutically effective in 50% ofthe population). The dose ratio between toxic and therapeutic effects isthe therapeutic index and it can be expressed as the ratio LD₅₀/ED₅₀.Compounds which exhibit high therapeutic indices are preferred. Whilecompounds that exhibit toxic side effects can be used, care should betaken to design a delivery system that targets such compounds to thesite of affected tissue in order to minimize potential damage touninfected cells and, thereby, reduce side effects.

The data obtained from cell culture assays and animal studies can beused in formulating a range of dosage for use in humans. The dosage ofsuch compounds lies preferably within a range of circulatingconcentrations that include the ED₅₀ with little or no toxicity. Thedosage can vary within this range depending upon the dosage formemployed and the route of administration utilized. For any compound usedin the method of the invention, the therapeutically effective dose canbe estimated initially from cell culture assays. A dose can beformulated in animal models to achieve a circulating plasmaconcentration range that includes the IC₅₀ (i.e., the concentration ofthe test compound which achieves a half-maximal inhibition of symptoms)as determined in cell culture. Such information can be used to moreaccurately determine useful doses in humans. Levels in plasma can bemeasured, for example, by high performance liquid chromatography.

A therapeutically effective amount of a pharmaceutical compositiontypically ranges from about 0.001 to 100 mg/kg body weight, preferablyabout 0.01 to 25 mg/kg body weight, more preferably about 0.1 to 20mg/kg body weight, and even more preferably about 1 to 10 mg/kg, 2 to 9mg/kg, 3 to 8 mg/kg, 4 to 7 mg/kg, or 5 to 6 mg/kg body weight. Thepharmaceutical composition can be administered at various intervals andover different periods of time as required, e.g., multiple times perday, daily, every other day, once a week for between about 1 to 10weeks, between 2 to 8 weeks, between about 3 to 7 weeks, about 4, 5, or6 weeks, etc. The skilled artisan will appreciate that certain factorscan influence the dosage and timing required to effectively treat asubject, including but not limited to the severity of the disease ordisorder, previous treatments, the general health and/or age of thesubject, and other diseases present. Generally, treatment of a subjectwith an inventive composition can include a single treatment or, in manycases, can include a series of treatments.

Exemplary doses include milligram or microgram amounts of the inventivecompounds per kilogram of subject or sample weight (e.g., about 1microgram per kilogram to about 500 milligrams per kilogram, about 100micrograms per kilogram to about 5 milligrams per kilogram, or about 1microgram per kilogram to about 50 micrograms per kilogram.) For localadministration (e.g., intranasal), doses much smaller than these may beused. It is furthermore understood that appropriate doses depend uponthe potency of the agent, and may optionally be tailored to theparticular recipient, for example, through administration of increasingdoses until a preselected desired response is achieved. It is understoodthat the specific dose level for any particular subject may depend upona variety of factors including the activity of the specific compoundemployed, the age, body weight, general health, gender, and diet of thesubject, the time of administration, the route of administration, therate of excretion, any drug combination, and the degree of expression oractivity to be modulated.

The invention further provides pharmaceutical compositions comprisingtwo or more molecular species of the invention, each comprising a moietythat binds to a cellular marker on noncellular molecular entity, whereinthe binding moieties in each molecular species bind to a differentcellular marker. The invention further provides pharmaceuticalcompositions comprising one or more molecular species of the inventionand an additional active agent. The additional active agent may be anagent that is effective for treatment of a macular degeneration relatedcondition, diabetic retinopathy, or CNV. In certain embodiments of theinvention the additional active agent is selected from the groupconsisting of: angiogenesis inhibitors, antiinflammatory agents,antiangiogenic steroids, and growth factors. Angiogenesis inhibitors arediscussed further below. The additional active agent can be anantibiotic or an antiinflammatory agent not necessarily effectivespecifically for treatment of a macular degeneration related condition,diabetic retinopathy, or CNV.

Angiogenesis Inhibitors

Certain embodiments of the present invention make use of one or moreangiogenesis inhibitors. Angiogenesis inhibitors can be divided intoseveral groups based on their primary mechanism of action. One groupincludes cytotoxic agents that damage or kill target cells (e.g.,endothelial cells) or that trigger an immune-mediated response thatresults in damage to or killing of target cells. A second group includesagents that do not substantially damage or kill endothelial cells butinstead inhibit their proliferation, migration, capillary tubeformation, or other processes associated with angiogenesis. Angiogenesisinhibitors falling into either or both of these groups can be used.

Angiogenesis inhibitors include, but are not limited to, Macugen® oranother VEGF nucleic acid ligand; Lucentis®, Avastin®, or anotheranti-VEGF antibody; combretastatin or a derivative or prodrug thereofsuch as Combretastatin A4 Prodrug (CA4P); VEGF-Trap; EVIZON™ (squalaminelactate); AG-013958 (Pfizer, Inc.); JSM6427 (Jerini A G); a shortinterfering RNA (siRNA) that inhibits expression of one or more VEGFisoforms (e.g., VEGF₁₆₅); and an siRNA that inhibits expression of aVEGF receptor (e.g., VEGFR1). Other angiogenesis inhibitors includevarious endogenous or synthetic peptides such as angiostatin, arresten,canstatin, combstatin, endostatin, thrombospondin, and tumstatin. Otherantiangiogenic molecules include thalidomide and its antiangiogenicderivatives such as iMiDs (Bamias A, Dimopoulos M A. Eur J Intern Med.14(8):459-469, 2003; Bartlett J B, Dredge K, Dalgleish A G. Nat RevCancer. 4(4):314-22, 2004). β2-glycoprotein 1 (β2-GP1) is anangiogenesis inhibitor of particular interest in the present invention.

Macugen (Pfizer, Eyetech) is a VEGF nucleic acid ligand (also referredto as an aptamer) that binds to and inhibits VEGF₁₆₅ (U.S. Pat. No.6,051,698). Lucentis (Genentech) is a humanized antibody fragment thatbinds and inhibits Vascular Endothelial Growth Factor A (VEGF-A).(Gaudreault, J., et al., Invest Ophthalmol. Vis. Sci. 46, 726-733 (2005)and references therein. Avastin (Genentech) is a full length humanizedantibody that also binds to VEGF. Candy (Acuity Pharmaceuticals,Philadelphia, Pa.) is a short interfering RNA (siRNA) designed toinhibit expression of VEGF. sima-027 (Sima Therapeutics; Boulder Colo.)is a chemically modified siRNA designed to inhibit expression of theVEGF receptor known as VEGFR1.

Compositions Comprising Compstatin or a Complement Inhibiting AnalogThereof and a Gel-Forming Material

The invention provides a variety of compositions comprising agel-forming material and a therapeutic agent, wherein said therapeuticagent is effective for treating a retinal disorder characterized bymacular degeneration, CNV, or both. In various embodiments of theinvention the therapeutic agent is a compstatin analog. The compositionmay comprise one or more additional therapeutic agents effective fortreating the retinal disorder. Suitable agents are described elsewhereherein. In certain embodiments the gel-forming material is soluble,e.g., in an aqueous medium.

The invention encompasses the recognition that gel-forming compositionscomprising a soluble collagen are useful for the delivery of therapeuticagents such as peptides or peptidomimetics to the posterior segment ofthe eye. The collagen is initially soluble and forms a solution that hasa low viscosity but is capable of rapid formation of a gel underappropriate conditions, e.g., conditions encountered upon administrationto a mammalian subject. The invention therefore provides a system fordelivery of peptides or peptidomimetics to the posterior segment of theeye for treatment of eye disorders. The system is designed to localizesuch molecules in sufficient concentration to provide sustained deliverywhile at the same time allowing the macromolecule to be released insufficient amounts so that it can diffuse to a site of action in theposterior segment of the eye, e.g., the retina, RPE, subretinal space,Bruch's membrane, and/or choriocapillaris. In addition, the collagen gelmay protect the peptides or peptidomimetics from degradation, e.g., byendogenous proteases.

In addition to their use for delivering peptides and peptidomimeticssuch as compstatin and analogs thereof, a variety of biologicalmacromolecules useful for the treatment of eye disorders characterizedby macular degeneration, CNV, RNV, ocular inflammation, or anycombination of the foregoing, can be delivered using the collagencompositions of the invention. Any of the agents mentioned herein, e.g.,angiogenesis inhibitors such as Macugen, Lucentis, etc., can bedelivered either singly or in combination with one or more other agents.The collagen compositions can also be used to deliver agents that arenot biological macromolecules. The invention therefore provides acomposition comprising: (i) a therapeutic agent effective for thetreatment of an eye disorder characterized by macular degeneration, CNV,RNV, ocular inflammation, or any combination of the foregoing; and (ii)a soluble gel-forming material. In certain embodiments of the inventionthe agent is a complement inhibitor, e.g., a viral complement controlprotein (VCCP) or viral complement inhibiting protein (VCIP). As notedabove, VCCPs and VCIPs are discussed in copending U.S. patentapplication entitled VIRAL COMPLEMENT CONTROL PROTEINS FOR EYEDISORDERS, filed Oct. 8, 2005. VCCPs include, but are not limited to,vaccinia complement control protein (VCP), smallpox inhibitor ofcomplement protein (SPICE), and complement inhibiting fragments andvariants thereof, e.g., fragments that contain at least four shortconsensus repeats. The complement inhibitor may, but need not be, apolypeptide or peptide. The composition forms a gel followingintroduction into the body, e.g., upon contact with a physiologicalfluid. The composition can also form a gel upon contact with a fluidsuch as phosphate buffered saline, or other fluid containing appropriateions. Thus the composition can be injected at an appropriate location,e.g., in close proximity to the posterior segment of the eye, where itforms a gel. Alternately, a preshaped gel implant can be made, e.g., byintroducing the solution into a mold or cavity of the desired shape andallowing gel formation to occur in the presence of a suitableconcentration of a salt. The salt can be added either prior to orfollowing the introduction of the solution into the mold or cavity. Themold or cavity can be, e.g., any structure that contains a hollow spaceor concave depression into which a solution can be introduced. Inanother embodiment, a film or membrane is formed from the collagensolution containing a therapeutic agent.

Release of the agent from the gel can occur by any mechanism, e.g., bydiffusion of the agent out of the gel, as a result of breakdown of thegel, or both. One aspect of the invention is the selection of suitableconcentrations of soluble collagen and collagen solids that result in agel that retains the agent within the gel so as to provide sustaineddelivery for a desired period of time while also permitting release ofthe agent from the gel in sufficient concentration to be effective atits site of action in the posterior segment of the eye.

In accordance with certain embodiments of the invention, a solutioncontaining the soluble collagen and a therapeutic agent is prepared bycombining the soluble collagen and therapeutic agent in solution usingany suitable method, e.g., by adding the therapeutic agent to a solutioncontaining soluble collagen. The composition is delivered locally to anappropriate location in or near the eye of a mammalian subject,typically to an area outside of and in close proximity to the posteriorsegment of the eye. The solution rapidly forms a gel at or close to ofthe site of administration. The therapeutic agent is entrapped withinthe gel. The therapeutic agent diffuses out of the gel or is released asthe gel degrades over time, thereby providing a continuous supply of theagent to tissues and structures that are either in direct physicalcontact with the gel or located nearby. In certain embodiments thesolution is administered behind the sclera of the eye, as discussedfurther below. Delivery can be accomplished by injection (e.g., using a30 gauge needle or the like), by catheter, etc., as further describedbelow.

A variety of different collagen preparations can be used in the presentinvention provided that the collagen is initially soluble and is capableof rapidly forming a gel under appropriate conditions. Suitable collagenpreparations, and methods for their manufacture, are described, e.g., inU.S. Pat. Nos. 5,492,135; 5,861,486; 6,197,934; 6,204,365; and WO00/47130, but the invention is not limited to such preparations ormethods. These collagens are prepared in soluble form and rapidly form agel upon exposure to physiological fluids or other fluids havingsuitable concentration of ions. In accordance with the presentinvention, injecting or otherwise introducing the collagen solution tothe eye or near the eye results in gel formation, presumably induced bycontact with physiological fluids. However it is noted that theinvention is in no way limited by the mechanism by which gel formationoccurs. In addition, as noted above, the gel can be formed in vitro andthem implanted at an appropriate location, e.g., in close proximity tothe posterior segment of the eye.

One suitable method of preparing a soluble collagen solution involvesextracting collagen from a natural source, acid solubilizing thecollagen, and dialyzing the solubilized collagen against a solutioncontaining a chelating agent, e.g., a metal chelating agent such asethylenediamine tetraacetic acid, disodium salt dihydrate (EDTA), whileraising the pH. One or more dialysis steps against a solution such asdeionized water lacking the chelating agent may also be performed.Unlike standard collagen solutions that undergo spontaneousfibrillogenesis at neutral pH and room temperature, collagen solutionsfor use in the present invention remain in solution during storage forextended periods of time and rapidly undergo gel formation when exposedto physiological fluids. While not wishing to be bound by any theory,the chelating agent may alter the concentration of one or more cationsand thereby prevent fibrillogenesis that would otherwise occur as the pHis raised. The chelating agent may have other desirable effects on thecollagen solution, and in certain embodiments of the invention thecollagen solution comprises a chelating agent, e.g., EDTA. The chelatingagent may remain in the collagen solution following dialysis or may beadded to the collagen solution. The concentration of the chelating agentmay range, for example, between about 0.02M and about 0.05M, e.g.,between about 0.025M and about 0.035M. Other chelating agents may alsobe used including, but not limited to, those described in U.S. Pat. No.5,861,486.

In certain embodiments the collagen solution has a concentration ofsoluble collagen ranging between 1 mg/ml and 100 mg/ml, e.g., between 10mg/ml and 70 mg/ml, between 20 mg/ml and 50 mg/ml, e.g., 30 mg/ml, etc.In certain embodiments of the invention the pH of the collagen solutionis between 6.0 and 8.0, e.g., between 6.5 and 7.5, e.g., 7.0.

In certain embodiments of the invention the collagen composition furthercomprises a fibrillar component comprising fibrillar collagen solids.For example, certain collagen compositions contain between 0.5 mg/ml and30 mg/ml fibrillar collagen solids, or between 1 mg/ml and 20 mg/mlfibrillar collagen solids, e.g., 2 mg/ml, 3 mg/ml, 4 mg/ml, 5 mg/ml, 6mg/ml, 8 mg/ml, 10 mg/ml, etc. In terms of percent fibrillar collagensolids on a weight/volume basis, certain collagen compositions containbetween 0.05 and 3% fibrillar collagen solids or between 0.1 and 2%fibrillar collagen solids, e.g., 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.8%, 1%,1.2%, etc. Any suitable fibrillar component can be used in the collagencompositions of the invention. Fibrillar collagen solids can be preparedusing a variety of methods. For example, fibrillar collagen may bereconstituted collagen prepared from animal sources such as bovine hide(Frontiers in Matrix Biology, Vol. 10, pp. 1-58, in Methods ofConnective Tissue Research, Eds. Robert, Moczar, and Moczar, S. Karger,Basel, 1985). Fibrillar collagen may be prepared from human or animalsources as described in U.S. Pat. Nos. 4,969,912 and 5,322,802. Thefibrillar collagen solids are suspended in solution at a concentrationtypically ranging from about 10-100 mg/ml. The collagen suspensioncontaining fibrillar collagen solids is combined with, e.g., added to, asoluble collagen composition either prior to or following addition ofthe therapeutic agent to a solution comprising soluble collagen.

In some embodiments of the invention the soluble collagen preparationcomprises a chemical cross-linking agent. The agent may crosslinkcollagen molecules and/or fibrils to one another and/or may crosslink atherapeutic agent such as compstatin or an analog thereof to a collagenmolecule or fibril. Typical cross-linking agents crosslink collagenamine groups to one another or to amine, carboxyl, phenol, sulfonyl, orcarbohydrate groups of therapeutic agents. Suitable cross-linking agentsinclude, but are not limited to, those described in WO 00/47130. Withoutwishing to be bound by any theory, cross-linking may stabilize thecollagen gel (e.g., decrease its rate of breakdown) and/or decrease therate of release of the therapeutic agent from the gel.

Without wishing to be bound by any theory, the presence of fibrillarcollagen solids may have any of a variety of advantageous effects. Byway of non-limiting example, the fibrillar collagen solids may increasethe in vivo stability of the collagen gel, e.g., they may decrease therate of breakdown of the gel. The fibrillar collagen solids may increasethe stability of a therapeutic agent contained in the gel and/ordecrease or modulate the rate at which the agent is released from thegel by diffusion and/or breakdown of the gel.

The collagen preparations preferably form a gel within 5 minutes (300seconds) following contact with physiological fluids. More preferablythe collagen preparations form a gel within 90 seconds, 2 minutes (120seconds) or within 3 minutes (180 seconds) following contact withphysiological fluids. Preparations that form a gel within shorter timeperiods, e.g., within 5-90 seconds, or longer time periods, e.g., 3-5minutes, can also be used.

Any of collagen types I-XXVIII, or mixtures thereof, can be used in thepresent invention. The collagen can be purified from natural sources(e.g., human tissue or animal tissue such as bovine, rabbit, etc.) asdescribed in the above-referenced patents and publications.Alternatively, the collagen can be manufactured using recombinant DNAtechniques, in which case the sequence can be of human or animal origin.See, e.g., U.S. Pat. Nos. 5,593,854 and 5,667,839. Methods for theproduction of proteins, e.g., a polypeptide of interest such as acollagen chain, using recombinant DNA technology are well known in theart. Suitable methods include those described above. The term “collagen”includes collagen fragments. Thus in certain embodiments the solublecollagen comprises or consists of a collagen fragment or combination offragments. In certain embodiments a complete collagen polypeptide chainis used.

While collagen preparations such as those described above areparticularly preferred in certain embodiments of the invention, avariety of other gel-forming materials could also be used in agel-forming composition of the invention. In certain embodiments the gelis a hydrogel, by which is meant a gel that contains a substantialamount of water. Preferably the material and the gel that it forms arebiocompatible. In certain embodiments the material and the gel that itforms are biodegradable. A variety of modified or derivatized collagensare also of use in various embodiments of the invention. See, e.g., U.S.Pat. No. 5,201,764. For example, collagen can be acylated with one ormore acylating agents such as glutaric anhydride, succinic anhydride,and maleic anhydride and at least one other acylating agent selectedfrom the group consisting of methacrylic anhydride, beta-styrenesulfonyl chloride, ethylene-maleic anhydride copolymer, styrene-maleicanhydride copolymer or poly(vinyl) sulfonic acid.

Other gel-forming materials include, but are not limited to, hyaluronicacid and modified forms thereof, polysaccharides such as alginate andmodified forms thereof, self-assembling peptides, etc. See, e.g., U.S.Pat. No. 6,129,761 for further description of alginate and modifiedforms thereof, hyaluronic acid and modified forms thereof, andadditional examples of soluble gel-forming materials that are of use invarious embodiments of the present invention. As described therein,other polymeric hydrogel precursors include polyethyleneoxide-polypropylene glycol block copolymers such as Pluronics™ orTetronics™ which are crosslinked by hydrogen bonding and/or by atemperature change, as described in Steinleitner et al., Obstetrics &Gynecology, 77:48-52 (1991); and Steinleitner et al., Fertility andSterility, 57:305-308 (1992). Other materials which may be utilizedinclude proteins such as fibrin or gelatin. Polymer mixtures also may beutilized. For example, a mixture of polyethylene oxide and polyacrylicacid which gels by hydrogen bonding upon mixing may be utilized.

Covalently crosslinkable hydrogel precursors also are useful. Forexample, a water soluble polyamine, such as chitosan, can becross-linked with a water soluble diisothiocyanate, such as polyethyleneglycol diisothiocyanate. The isothiocyanates will react with the aminesto form a chemically crosslinked gel. Aldehyde reactions with amines,e.g., with polyethylene glycol dialdehyde also may be utilized. Ahydroxylated water soluble polymer also may be utilized.

Alternatively, polymers may be utilized which include substituents whichare crosslinked by a radical reaction upon contact with a radicalinitiator. For example, polymers including ethylenically unsaturatedgroups which can be photochemically crosslinked may be utilized, asdisclosed in WO 93/17669, the disclosure of which is incorporated hereinby reference. In this embodiment, water soluble macromers that includeat least one water soluble region, a biodegradable region, and at leasttwo free radical-polymerizable regions, are provided. The macromers arepolymerized by exposure of the polymerizable regions to free radicalsgenerated, for example, by photosensitive chemicals and or light.Examples of these macromers are PEG-oligolactyl-acrylates, wherein theacrylate groups are polymerized using radical initiating systems, suchas an eosin dye, or by brief exposure to ultraviolet or visible light.Additionally, water soluble polymers which include cinnamoyl groupswhich may be photochemically crosslinked may be utilized, as disclosedin Matsuda et al., ASAID Trans., 38:154-157 (1992).

In general, the polymers are at least partially soluble in aqueoussolutions, such as water, buffered salt solutions, or aqueous alcoholsolutions. Methods for the synthesis of the other polymers describedabove are known to those skilled in the art. See, for example ConciseEncyclopedia of Polymer Science and Polymeric Amines and Ammonium Salts,E. Goethals, editor (Pergamen Press, Elmsford, N.Y. 1980). Manypolymers, such as poly(acrylic acid), are commercially available.Naturally occurring and synthetic polymers may be modified usingchemical reactions available in the art and described, for example, inMarch, “Advanced Organic Chemistry,” 4th Edition, 1992,Wiley-Interscience Publication, New York.

Water soluble polymers with charged side groups may be crosslinked byreacting the polymer with an aqueous solution containing ions of theopposite charge, either cations if the polymer has acidic side groups oranions if the polymer has basic side groups. Examples of cations forcrosslinking of the polymers with acidic side groups to form a hydrogelare monovalent cations such as sodium, and multivalent cations such ascopper, calcium, aluminum, magnesium, strontium, barium, and tin, anddi-, tri- or tetra-functional organic cations such as alkylammoniumsalts. Aqueous solutions of the salts of these cations are added to thepolymers to form soft, highly swollen hydrogels and membranes. Thehigher the concentration of cation, or the higher the valence, thegreater the degree of cross-linking of the polymer. Additionally, thepolymers may be crosslinked enzymatically, e.g., fibrin with thrombin.In some embodiments a self-assembling peptide, such as those describedin U.S. Pat. No. 6,800,481 is used. These peptides self-assemble to forma hydrogel structure upon contact with monovalent cations, e.g., such asthose present in extracellular fluid.

In embodiments of the invention in which the gel is formed bycross-linking polymer chains to one another, the composition can includean appropriate cross-linking agent, which is selected according to theparticular polymer. Alternately, the cross-linking agent can beadministered after administration of the composition containing thegel-forming material, at substantially the same location. Any of thesegels can be formed in vitro, e.g., as described above for gelscomprising soluble collagen, and implanted at an appropriate location inor in the vicinity of the eye.

In certain embodiments of the invention the composition contains cellsthat produce and secrete compstatin or a complement inhibiting analogthereof instead of, or in addition to, containing the molecule itself.In these embodiments, the gel may be resistant to degradation, so thatit traps the cells therein for a sustained period of time.

Methods of Administration, Dose, and Dosing Regimens for a CompositionComprising a Gel-Forming Material

Any suitable method may be used to administer the gel-formingcompositions of the invention to a location in or near the posteriorsegment of the eye. As shown in FIGS. 1A and 1B, the eye can be dividedinto an anterior segment and a posterior segment. The sclera, which is athin, avascular layer of tissue, covers the outside of the eye aroundthe posterior segment and part of the anterior segment and is continuouswith the cornea, the transparent covering of the front of the eye. Thechoroid and retina underlie the sclera. The optic nerve transmits nerveimpulses from the retina along the visual pathways.

The composition may be administered by a periocular approach, which termis used to refer to any route of administration that locally delivers acomposition into the region outside the eye, i.e., exterior to thesclera. The composition is thus delivered to an area outside of and inclose proximity to the posterior segment of the eye. In certainembodiments a composition administered in close proximity to theposterior segment of the eye is administered such that at least one edgeor surface of the gel is within 10 mm of at least one point on theexterior surface of the portion of the sclera that covers the outside ofthe posterior segment of the eye. Preferably at least one edge orsurface of the gel is within 5 mm of at least one point on the exteriorsurface of the portion of the sclera that covers the outside of theposterior segment of the eye. In certain embodiments at least one edgeor surface of the gel is within 1-2 mm of at least one point on theexterior surface of the portion of the sclera that covers the outside ofthe posterior segment of the eye, or within 1 mm or less of at least onepoint on the exterior surface of the portion of the sclera that coversthe outside of the posterior segment of the eye.

Periocular administration may be accomplished using, e.g., retrobulbar,peribulbar, sub-Tenon, or subconjunctival injection, by subretinalinjection, by suprachoroidal injection, or by use of a catheter orcannula directed to any of the regions accessed by the afore-mentionedtechniques. Most commonly a syringe is used, but a pump or any othersource of pressure could also be used. In certain preferred embodimentsof the invention the composition is administered adjacent to the sclera,outside the eye, e.g., by retrobulbar, sub-Tenon, or subconjunctivalinjection. At least one surface of the gel may be in direct contact withthe sclera. Methods suitable for administration of local anesthesia forophthalmic surgery are of use to deliver a composition of the invention.See, e.g., Dutton, J J, et al., “Anesthesia for intraocular surgery”,Surv Ophthalmol. 46(2):172-84, 2001; Canavan, K. S., et al.,“Sub-Tenon's administration of local anaesthetic: a review of thetechnique”, British Journal of Anaesthesia, 90(6), 787-793, 2003. Seealso, Spaeth, supra, and Albert and Lucarelli, supra. Compositionsdelivered according to these standard techniques are considered to bedelivered in close proximity to the posterior segment of the eye. Thecomposition forms a gel which, in certain embodiments of the inventionat least partially overlies the macula. In certain embodiments of theinvention the composition is administered into the sclera itself, e.g.,by injection or using a catheter or cannula (see, e.g., U.S. Pat. No.6,378,526). The therapeutic agent is released from the composition anddiffuses from its site of release across the sclera and into the eye,where it reaches a site of activity at the retina. Alternately, a gelstructure formed in vitro can be implanted in or in the vicinity of theeye.

The amount and concentration of the therapeutic agent(s) in acomposition comprising soluble collagen can vary depending on a numberof factors including, but not limited to, the identity of thetherapeutic agent(s), the condition being treated and its severity, thepresence or absence of fibrillar collagen and/or chemical cross-linkingagents in the composition, the total amount of composition administered(which itself can vary based on various considerations such as theanatomy of the patient, etc.) It may be desirable to employ aconcentration and/or total amount of therapeutic agent(s) that willmaximize the total amount of agent delivered to the eye, while keepingthe concentration actually released from the gel below that which couldcause unacceptable side effects. In certain embodiments of the inventionthe total amount and concentration of the agent(s) are selected toprovide an effective concentration of the agent at the retina over aperiod of at least 4 weeks, e.g., 4-6 weeks, 6 weeks or greater, 8 weeksor greater, etc.

The dosing interval (i.e., the time between individual administrationsof an inventive composition) and the dose of the therapeutic agentdelivered with each administration can vary. In certain embodiments thecomposition is delivered at times more than 6 weeks apart, e.g., 2, 3,4, 5, or 6 months apart, or any intervening number of weeks, e.g., 8,10, 12, 14, 16 weeks, etc. In other embodiments the composition isdelivered at even greater time intervals, e.g., at times 7, 8, 9, 10,11, or 12 months apart. In other embodiments the time interval is 6weeks or less. Of course the time interval can vary. For example, thetime intervals between doses can alternate between 6 weeks or less andmore than 6 weeks. In certain embodiments the average time intervalbetween administrations of an inventive composition is at least 6 weeks,e.g., 2, 3, 4, 5, or 6 months, or any intervening number of weeks, e.g.,8, 10, 12, 14, 16 weeks, etc. In certain embodiments of the inventionthe composition is administered multiple times at time intervals onaverage at least 6 weeks apart, at least 8 weeks apart, at least 10weeks apart, at least 12 weeks apart, etc. Typically the composition isadministered at least 2, 5, 10, 20, 50, or more times. The compositioncan and often will be administered indefinitely to a subject sufferingfrom or at risk of a macular degeneration related condition, CNV, RNV,ocular inflammation, etc.

The total amount of therapeutic agent and its concentration in the gelcan also vary. Exemplary, nonlimiting, doses are between approximately0.1 and 100 mg/dose for each eye to be treated, e.g., betweenapproximately 0.5 and 50 mg/dose, between 1 and 10 mg/dose, etc.Exemplary, nonlimiting concentrations of a therapeutic agent in acomposition of the invention are between approximately 0.1 and 100 mg ofthe therapeutic agent per milliliter of collagen solution, e.g., theconcentration may be between 1 and 50 mg/ml, between 1 and 10 mg/ml,etc.

In some embodiments a dose of a first therapeutic agent such ascompstatin or a complement inhibiting analog thereof is administeredintravitreally, and a composition of the invention comprising a secondtherapeutic agent, which can be the same as or different to the firsttherapeutic agent, is administered to the subject using a periocularadministration technique, with the two administrations occurring withina reasonably narrow period of time, e.g., within up to about 6 weeks ofone another. The intravitreal administration may provide an initial highconcentration of the therapeutic agent at the retina. The periocularadministration then provides a sustained release of the therapeuticagent over time.

Testing Therapeutic Potential in Animal Models and Humans

A number of different animal models that attempt to replicate one ormore features of macular degeneration, diabetic retinopathy, choroidalneovascularization, and/or ocular inflammation are known in the art. Acomposition containing compstatin or a complement inhibiting analogthereof can be administered in various doses to mice, rats, dogs,primates, etc. that have spontaneous macular degeneration and/orchoroidal neovascularization or in which macular degeneration and/orchoroidal neovascularization have been induced by a treatment. Theability of the compound to prevent or treat one or more signs orsymptoms of macular degeneration (e.g. CNV, accumulation of lipofuscinin and/or drusen beneath the RPE, photoreceptor atrophy or hypertrophy,altered RPE pigmentation, photoreceptor loss, altered electroretinogram,etc.) is assessed. Visual examination, photography, histopathology,immunohistology, etc., can be used.

Useful models include animals (e.g., non-human primates, etc.) in whichchoroidal neovascularization is induced by laser treatment (Bora, P. S.,et al., Proc. Natl. Acad. Sci. 100(5): 2679-2684, 2003; Zacks, D N, etal., Invest Ophthalmol V is Sci. 243(7):2384-91, 2002). Other modelsinclude animals that have been treated with a variety of agents such aslipid hydroperoxide (Tamai, K., et al., Exp Eye Res. 74(2):301-8, 2002),pellets comprising growth factors, etc. Animals genetically engineeredto overexpress or underexpress one or more genes are also useful. Itwill be appreciated that since the affinity of compstatin fornon-primate C3 is reported to be lower than that for human or non-humanprimate C3, doses that would inhibit primate C3 may be insufficient toinhibit non-primate C3. However, larger doses, relative to the amount ofC3, may be used.

The candidate agent can be administered systemically or locally. Theagent can be delivered orally, intravenously, intraperitoneally,intravitreally, transsclerally or topically. The agent can be deliveredby intravitreal injection, transclerally, by sustained release implant,etc. The eye can be analyzed by ophthalmoscopy, angiography,histopathology or a combination thereof. Any of these methods can beused to assess efficacy of a candidate agent in any animal model. Modelsalso exist for diabetic retinopathy. Animal models for ocularinflammation are also known in the art. For example, experimentalallergic uveitis is a well-known model system (Singh, V K., et al.,Indian J Med. Res., 107:53-67, 1998). Endotoxin-induced uveitis isanother useful model (Kozhich, A. T., et al., InvestigativeOphthalmology and Visual Science, 41:1823-1826, 2000.) These examplesare but a few of the model systems in which efficacy of the compounds ofthe invention can be assessed.

Compounds that show promising results in animal studies including, butnot limited to, acceptable safety and feasibility of administering adose expected to effectively inhibit complement in the human vitreous,are tested in humans, e.g., using standard protocols and endpoints forclinical trials for therapies for ARMD or diabetic retinopathy. It willbe appreciated that in the case of many of the ocular conditions ofinterest herein, demonstrating efficacy in animal models is notnecessary in order to establish that a compound described herein isconsidered therapeutically useful by those of skill in the art and/orfor conducting clinical trials in humans.

In addition to protocols and endpoints that have typically been employedin evaluating therapies for wet ARMD in humans, the present inventioncontemplates testing the inventive compositions to establish theirutility in inhibiting progression from the dry form of ARMD to the wetform, in inhibiting development of dry ARMD in a subject at riskthereof, or in inhibiting progression from a mild to a more severe formof dry ARMD. Accordingly, in some embodiments the compositions areadministered to subjects who have been diagnosed with the dry type ofARMD or determined to be at risk of developing ARMD. The ability of thecomposition to inhibit progression of the dry form of ARMD to wet typeARMD or to inhibit development of dry ARMD is assessed. In certainembodiments of the invention subjects who are at increased risk ofdeveloping ARMD as compared with the general population of the same age,are selected for therapy. In certain embodiments of the inventionsubjects suffering from dry ARMD who are at high risk of progressing towet ARMD, e.g., patients already suffering from wet ARMD in one eye,patients with a genetic disposition toward severe ARMD, or with anyother indicators, are selected for therapy. Polymorphisms that increaserisk of developing ARMD are mentioned above and described in more detailin the literature. In one embodiment the subject is tested to determinewhether the subject has a polymorphism in the CFH, CFB, TLR4, orLOC387715 locus. Subjects determined to be at increased risk as a resultof being homozygous or heterozygous one or more genetic polymorphismsknown to be associated with ARMD are selected for therapy. In oneembodiment, the subject is heterozygous or homozygous for 1, 2, 3, ormore polymorphisms known to be associated with increased risk of ARMD,e.g., increased risk of developing ARMD, increased risk of progressingfrom dry to wet ARMD, increased risk of developing a severe form ofARMD, etc.

Subjects may be classified as having early, intermediate, or advancedARMD in accordance with the classification scheme used in theAge-Related Eye Diseases Study (AREDS), which is set forth in guidelinesdeveloped American Academy of Ophthalmology (American Academy ofOphthalmology, Age Related Macular Degeneration Preferred PracticePattern™, 2003; available for download at URL www. followed immediatelyby aao.org/aao/education/library/ppp/amd_new.cfm).

In one example, subjects with the dry type of ARMD are divided into twogroups. One group receives a single intravitreal injection of theinventive composition, or a retrobulbar or sub-Tenon injection of theinventive composition in the vicinity one eye, e.g., in close proximityto the posterior segment of the eye, while the other group eitherreceives either no treatment or a single intravitreal injection ofanother therapeutic agent such as Macugen or Lucentis into one eye. Thegroups are monitored over a period of 6 months to 2 years to determinethe percentage of subjects that progress to the wet type of ARMD.

In another example, subjects with the dry type of ARMD are divided intotwo groups. One group receives a single intravitreal injection of theinventive composition, or a retrobulbar or sub-Tenon injection of theinventive composition in the vicinity of one eye, e.g., in closeproximity to the posterior segment of the eye, every 6 months while theother group either receives either no treatment or a single intravitrealinjection of another therapeutic agent such as Macugen or Lucentis intoone eye every 6 months. The groups are monitored over a period of 1-2years (or longer) to determine the percentage of subjects that progressto the wet type of ARMD. In another non-limiting example, subjects withdry type ARMD are divided into two groups. One group receives anintravitreal injection of the inventive composition, or a retrobulbar orsub-Tenon injection of the inventive composition in the vicinity of oneeye, e.g., in close proximity to the posterior segment of the eye, every3-6 months while the other group receives either no treatment orreceives treatment with Macugen or Lucentis according to the standardprotocols used for treating wet type ARMD, i.e., intravitreal injectionevery 4-6 weeks. The groups are monitored for a period of 1-2 years (orlonger) to determine the percentage of subjects that progress to the wetform of ARMD.

In another example, subjects with wet ARMD in at least one eye aredivided into two groups. One group is administered an intravitrealinjection of Lucentis or Macugen to the study eye, followed by anintravitreal injection of an inventive composition shortly thereafter(e.g., within 2 weeks). The other group is given an intravitrealinjection of Lucentis or Macugen into the study eye according tostandard protocols. The groups are monitored over time (e.g., 6 monthsto 2 years) to evaluate progression, recurrence of symptoms, need forretreatment, etc.

In another example the ability of an inventive composition to inhibitprogression of early ARMD (AREDS 2) to intermediate ARMD (AREDS 3) isassessed. Subjects with early ARMD are divided into two groups, one ofwhich receives an inventive composition as described in any of theexamples above while the other receives either no therapy or analternative therapy such as Lucentis or Macugen as described above. Thegroups are monitored for a period of time (e.g., as described above) todetermine the percentage of subjects that progress from early tointermediate ARMD.

In another example the ability of an inventive composition to inhibitprogression of intermediate ARMD (AREDS 3) to advanced ARMD (AREDS 4) isassessed. Subjects with intermediate ARMD are divided into two groups,one of which receives an inventive composition as described in any ofthe examples above while the other receives either no therapy or analternative therapy such as Lucentis or Macugen as described above. Thegroups are monitored for a period of time (e.g., as described above) todetermine the percentage of subjects that progress from intermediate toadvanced ARMD.

In addition to monitoring progression of ARMD, the incidence of sideeffects and complications may also be monitored. Consideration of sideeffects is an important aspect when evaluating the overall outcome andrisk/benefit ratio of a therapy. For example, if two therapies areequally efficacious in terms of inhibiting progression of or treatingARMD, the therapy with a lower incidence of side effects is typicallypreferred for most subjects. In certain embodiments of the inventiontherapy of a macular degeneration related condition such as ARMD, or CNVor RNV from any cause, using a composition of the invention isassociated with fewer side effects over time (e.g., over a 1-2 yearperiod) than a FDA-approved therapy for ARMD.

Identifying Subjects and Assessing Response

The methods of the invention may include providing a subject to which acomposition of the invention is to be administered. The subject istypically at risk of or suffering from an eye disorder characterized bymacular degeneration, choroidal neovascularization, retinalneovascularization, or any combination of these. The composition istypically administered to the subject with the intent of treating orpreventing development of such condition. Thus the subject willtypically have been identified as being at risk of or suffering fromsuch a condition. Methods for diagnosis of macular degeneration andchoroidal neovascularization and for assessing response to therapy areknown in the art. Any suitable tests and criteria can be used toidentify a subject at risk of or suffering from a macular degenerationrelated condition, diabetic retinopathy, or choroidal neovascularizationand/or to measure a response to therapy. Visual acuity can be measuredusing, for example, a Snellen chart, a Bailey-Lovie chart, a decimalprogression chart, a Freiburg visual acuity test, a measurement ofminimum angle of resolution (MAR) etc. Metamorphopsia (visualdistortion) may be measured using an Amsler chart. Contrast sensitivitymay be measured using a Pelli-Robson chart. Diagnostic studies include,but are not limited to, standard ophthalmologic examination of thefundus, stereo biomicroscopic examination of the macula, intravenousfundus fluorescein angiography, fundus photography, indocyanine greenvideo-angiography, and optical coherence tomography. A subjectdisplaying an abnormality on one or more of these diagnostic studies(e.g., a subject that falls outside a range that is considered normalfor a healthy eye) may be treated in accordance with the presentinvention. As noted above, subjects may be classified as having early,intermediate, or advanced ARMD in accordance with the classificationscheme used in the Age-Related Eye Diseases Study. A subject fallinginto any of the categories described therein, may be treated inaccordance with the present invention. If the subject has alreadydeveloped CNV, the subject may have classic CNV, occult CNV, or amixture of the two. Of course alternate classification schemes, of whicha variety is described in the literature, could also be used.

ARMD is known to have a genetic component, based on studies showing anincreased incidence of ARMD in individuals with relatives suffering fromARMD (e.g., twin studies) and on a number of recent studies showing thatpolymorphisms in a number of complement factors are associated withincreased risk of ARMD. Therefore, a subject may be considered at riskof developing ARMD if he or she has one or more close relatives (e.g.,parent, grandparent, sibling, cousin, uncle, aunt), who has received adiagnosis of ARMD. Individuals who smoke and/or consume a high fat dietare also at increased risk. The incidence of ARMD increases with age.Therefore, an individual over approximately 50 years of age, generallyat least 60 or at least 70 years of age may be considered at increasedrisk. An individual having drusen and one or more additional riskfactors may be at particular risk for developing ARMD. An individualwith multiple drusen, particularly if large and with indistinct borders,may be at particular risk. An individual with RPE hyperpigmentation orhypopigmentation or geographic atrophy may be at particular risk. Incertain embodiments of the invention the subject has one or more geneticpolymorphisms associated with increased likelihood of developing ARMD,some of which are noted above. In certain embodiments of the inventionthe method of treatment comprises determining whether the subject has agenetic polymorphism that increases the risk of ARMD. “Determining” asused here refers to establishing that a subject has a polymorphism thatincreases the risk of ARMD, either by performing or ordering a suitabletest, or by receiving results of a test performed or ordered by another,wherein the test ascertains whether the subject has the polymorphism. Itwill be appreciated that a useful genetic test need not be 100%accurate. Specific genetic mutations are associated with various lesscommon macular degeneration related conditions. A subject who hasreceived a diagnosis of diabetes is at risk of developing diabeticretinopathy.

Response to therapy can be assessed by any of the methods mentionedabove. Numerous studies have been conducted to assess the efficacy of avariety of different therapies in restoring vision, preventing visualloss, and/or resulting in improvement or slowing progression of ARMD orchoroidal neovascularization as judged by diagnostic tests such as thosedescribed above. One of ordinary skill in the art will be able to selectappropriate criteria by which to judge the efficacy of therapy.

Therapeutic Applications

The compositions of the invention can be administered to a subject(e.g., a human patient) to treat a macular degeneration relatedcondition (e.g., ARMD), diabetic retinopathy, retinopathy ofprematurity, persistent hyperplastic vitreous syndrome, choroidalneovascularization, etc. The subject may have exudative or nonexudativeARMD. In certain embodiments of the invention that subject has exudativeARMD but does not have RAP while in other embodiments the subject doeshave RAP. In certain embodiments, protocols that show promising resultsin clinical trials are employed.

One particularly advantageous use for the compositions and methods ofthe invention is to inhibit progression of non-exudative ARMD toexudative ARMD or to inhibit progression of non-exudative ARMD to a moresevere form. In certain embodiments of the invention an inventivecomposition inhibits progression of early ARMD (AREDS 2) to intermediateARMD (AREDS 3) or to advanced ARMD (AREDS 4). In certain embodiments ofthe invention the composition inhibits progression of intermediate ARMD(AREDS 3) to advanced ARMD (AREDS 4). Any of the compositions of theinvention may be used for one or more of these purposes in variousembodiments of the invention. Reference to various stages of ARMD asdescribed in the AREDS is in no way intended to be limiting. It will berecognized that other classification schemes could be used.

In a specific embodiment a composition of the invention, e.g., agel-forming composition of the invention, is used for treating subjectswith non-exudative ARMD, e.g., to prevent or inhibit progression toexudative ARMD. In certain embodiments the subject has not developeddetectable CNV and the composition prevents or delays the development ofCNV. For example, the subject may have dry ARMD, and the compositionprevents or delays the onset of wet ARMD. In certain embodiments thesubject has developed detectable CNV and the composition slows the rateof progression of CNV and/or causes regression of existing CNV. Incertain embodiments the subject has not developed detectable RNV and thecomposition prevents or delays the development of RNV. In certainembodiments the subject has developed detectable RNV and the compositionslows the rate of progression of RNV and/or causes regression ofexisting RNV. The composition can be administered once or multiple timesto a subject who does or does not have a condition such as CNV or RNV(or both), e.g., at approximately predetermined time intervals such as,for example, approximately every 4 weeks, approximately every 6 weeks,approximately every 8, 10, 12, 16, 20, 24 weeks, approximately every 6,8, 10, or 12 months, etc. It will be understood that in any of themethods of this invention, the composition should be administered in anamount effective to achieve the indicated result, within sound medicaljudgment. It should also be understood that the result need not beachieved in every instance.

Ancillary therapies may also be used concurrently, prior to, orfollowing treatment using the compositions and methods of the invention.Such therapies include, but are not limited to, administration ofantioxidant vitamin and/or mineral therapy, photodynamic therapy (e.g.,with verteporfin or other agents), administration of antiinflammatoryagents, antiangiogenic therapy (e.g., administration of one or moreangiogenesis inhibitors such as anecortave acetate or other angiostaticsteroids; anti-VEGF or anti-VEGFR antibody, antibody fragment, siRNA,antisense RNA, or aptamer; or any other antiangiogenic agent includingbut not limited to a small molecule, siRNA, antisense RNA, or aptamertargeted to any proangiogenic gene), growth factor administration,implantation of cells (e.g., neural stem cells, RPE stems cells, RPEcells) into the eye, laser photocoagulation, radiation therapy, thermaltherapy, and surgery (e.g., submacular surgery or maculartranslocation). In certain embodiments of the invention a growth factorfor RPE cells is administered, e.g., REF-1/TFPI-2 (Tanaka, Y, et al.,Invest Ophthalmol V is Sci. 45(1):245-52, 2004).

It may be desirable to treat an eye that already suffers from choroidaland/or retinal neovascularization (e.g., in a subject with diabeticretinopathy or ARMD) using photocoagulation or surgery and to alsoadminister a composition of the invention to the subject to preservevision in the other eye and/or prevent a recurrence of CNV and/or RNV inthe eye treated with photocoagulation or surgery.

EXAMPLES Example 1 Prevention of Choroidal Neovascularization in a MouseModel by Administration of a Compstatin Analog

Materials and Methods

Complement Inhibitors

Recombinant VCP was produced in and purified from a Pichia pastorisexpression system as described in (Sahu, A, et al., J. Immunol., 160,5596-5604, 1998). VCP was dissolved in physiological saline at variousconcentrations.

The compstatin analog shown in FIG. 2, in which positions 4 and 9 werealtered relative to the compstatin peptide, was chemically synthesizedand dissolved in physiological saline.

CNV Induction in Mice

C57BL/6 mice (The Jackson Laboratory) were anesthetized with a mixtureof ketamine/xylazine (8:1) and the pupils were dilated with a singledrop of 1% tropicamide. Krypton red laser photocoagulation (50-μm spotsize, 0.05s duration, 250 mW) will be used to generate laser spots insurrounding the optic nerve by using a hand-held coverslip as a contactlens. Formation of a bubble at the laser spot indicated rupture ofBruch's membrane. Multiple laser spots were generated in each eye.

Injection of VCP or Compstatin into the Eyes of Mice

Mice in which CNV has been previously laser-induced were administeredsolutions containing VCP or the compstatin analog by intravitrealinjection. Different groups of mice were injected with differentquantities of this molecule or of mouse albumin (as a control) todetermine the effect of dosage on the efficacy and toxicity of VCP.Briefly, after anesthesia and dilation of the pupil, the anteriorchamber was entered via the limbus with a 28-gauge needle to decompressthe eye. Under an operating microscope, which allows visualization ofthe retina, a 32-gauge (blunt) needle was passed through a scleralincision, just behind the limbus, into the vitreous cavity. A Hamiltonsyringe was used to inject between 1 and 3 μl of a solution containingeither VCP, the compstatin analog, or albumin.

Determination of Incidence and Size CNV

Seven days after CNV induction incidence of CNV was determined. Briefly,the mice were perfused with a FITC-dextran (Sigma-Aldrich) solution justprior to sacrifice. After the eyes were excised and fixed for 1 h in 10%phosphate-buffered formalin, RPE-choroid-scleral flat mounts wereprepared as follows. The cornea and the lens were removed and theneurosensory retina carefully dissected from the eyecup. Five radialcuts were from the edge of the eyecup to the equator; thesclera-choroidretinal pigment epithelium (RPE) complex was flat-mounted,with the sclera facing down, on a glass slide in Aquamount. The flatmounts were stained with an anti-elastin specific monoclonal antibody(Sigma-Aldrich) and then with a CY3-conjugated secondary antibody(Sigma-Aldrich) at a suitable concentration, e.g., at a 1/200 dilutionof a 1.0 mg/ml stock solution. Mounts were observed under confocalmicroscopy (LSM510, Zeiss). The prominent neovascular growth stainedgreen whereas the underlying elastin in the Bruch's membrane stained redwithin a laser spot. Images were analyzed with the image analysissoftware AxioVision (Zeiss). The amount of CNV was determined bymeasuring the total green-fluorescent surface area in each picture. Amean green-fluorescent area was obtained for the various groups andcompared using student t-test for comparisons between groups and ANOVAfor comparison among multiple groups. The number of spots studied was asfollows: No treatment control: 35 spots); mouse albumin control: 12spots; VCP (10 μg): 26 spots; VCP (30 μg): 14 spots; compstatin analog(30 μg): 27 spots. Deposition of a variety of different complementcomponents is also measured using immunological techniques and/orRT-PCR.

Results

The effects of VCP or the compstatin analog on the development of CNVwas tested in a murine model of laser-induced CNV. Briefly, VCP (either10 μg/eye or 30 μg/eye) or compstatin (30 μg/eye) was injected into thevitreous 24 hrs after laser induction. Seven days after CNV induction,incidence of CNV was determined. Just prior to sacrifice, the mice wereperfused with a FITC-dextran (Sigma-Aldrich) solution. After the eyeswere excised and fixed in 10% phosphate-buffered formalin,RPE-choroid-scleral flat mounts were prepared and stained with ananti-elastin specific monoclonal antibody (Sigma-Aldrich) and then witha CY3-conjugated secondary antibody (Sigma-Aldrich). Mounts wereobserved under confocal microscopy (LSM510, Zeiss). The prominentneovascular growth stained green whereas the underlying elastin in theBruch's membrane stained red within a laser spot. Similar results wereobtained with VCP and with the compstatin analog. Images were analyzedwith the image analysis software AxioVision (Zeiss). The amount of CNVwas determined by measuring the total green-fluorescent surface area ineach picture. A mean green-fluorescent area was obtained for the variousgroups and compared using student t-test for comparisons between groupsand ANOVA for comparison among multiple groups. Results are described inTable 2 and in the graph in FIG. 4. In Table 2, “compstatin” refers tothe compstatin analog shown in FIG. 2. As is evident both from the tableand the graph, administration of 30 μg of VCP or the compstatin analogcaused a statistically significant reduction in the mean area of CNVrelative to either no treatment or administration of albumin. Thecompstatin analog appeared to be somewhat more effective than VCP on aμg basis, although the difference was not statistically significant atthese sample sizes.

TABLE 2 Effect of VCP or a Compstatin Analog on Development of CNV in aMouse Model Multiple Comparisons Dependent Variable: FldAreaGreenTamhane Mean 95% Confidence Interval (I) Group (J) Group Difference(I-J) Std. Error Sig. Lower Bound Upper Bound No-treatment controlNo-treatment control Mouse Albumin Control 1909.00993 1090.44317 .601−1325.1110 5143.1309 VCP 10 ug −666.84488 1151.10903 1.000 −4015.64472681.9549 VCP 30 ug 4877.53314* 848.72770 .000 2345.4558 7409.6105Compstatin 30 ug 5194.92113* 846.05120 .000 2668.9363 7720.9060 MouseAlbumin Control No-treatment control −1909.00993 1090.44317 .601−5143.1309 1325.1110 Mouse Albumin Control VCP 10 ug −2575.854811053.13838 .182 −5733.0303 581.3207 VCP 30 ug 2968.52321* 710.20220 .013533.9807 5403.0657 Compstatin 30 ug 3285.91120* 707.00147 .006 853.11755718.7049 VCP 10 ug No-treatment control 666.84488 1151.10903 1.000−2681.9549 4015.6447 Mouse Albumin Control 2575.85481 1053.13838 .182−581.3207 5733.0303 VCP 10 ug VCP 30 ug 5544.37802* 800.23300 .0003101.1268 7987.6293 Compstatin 30 ug 5861.76601* 797.39374 .0003424.3034 8299.2287 VCP 30 ug No-treatment control −4877.53314*848.72770 .000 −7409.6105 −2345.4558 Mouse Albumin Control −2968.52321*710.20220 .013 −5403.0657 −533.9807 VCP 10 ug −5544.37802* 800.23300.000 −7987.6293 −3101.1268 VCP 30 ug Compstatin 30 ug 317.38799176.41849 .574 −214.1787 848.9547 Compstatin 30 ug No-treatment control−5194.92113* 846.05120 .000 −7720.9060 −2668.9363 Mouse Albumin Control−3285.91120* 707.00147 .006 −5718.7049 −853.1175 VCP 10 ug −5861.76601*797.39374 .000 −8299.2287 −3424.3034 VCP 30 ug −317.38799 176.41849 .574−848.9547 214.1787 Compstatin 30 ug *The mean difference is significantat the .05 level.

Example 2 Prevention of Choroidal Neovascularization in a Mouse Model byAdministration of a Compstatin Analog

Example 1 is repeated using a different compstatin analog. Doses rangingfrom 0.1-50 μg/eye are tested.

Example 3 Preparation of Collagen Solutions for a Gel-FormingComposition

Stock Collagen Preparation.

Collagen for all formulations will be prepared from porcine corium.Split porcine hide will be procured from Lampire Biological Laboratories(Pipersville, Pa.). Split hide will be rinsed with reagent alcohol andplaced in frozen storage prior to receipt. Sections of split corium willbe cut into small pieces (about 1 cm²), soaked in reagent alcohol, andthen washed extensively with sterile water. The washed pieces will beplaced in 20 volumes of 0.5M HCl for 30 minutes, washed with sterilewater and then placed in 20 volumes of 0.5N NaOH for 30 minutes. Bothtreatments have been shown to be effective in reducing viral titers byup to 6 logs. In addition, both treatments have been shown to havesignificant bactericidal effects, reducing bacterial loads by up to 9logs. The chemically disinfected corium will be washed extensively insterile water, weighed and placed in 20 volumes (v/w) of 0.5M aceticacid. The pieces will be stirred for 72 hours and porcine mucosal pepsinadded to the partially swollen corium.

Pepsin will be added at 2% (w/w wet corium) and stirred for 48 hours. Anadditional aliquot of pepsin will be added at 1% (w/w wet corium) andstirred for another 24 hours. At this point, the corium should be“dissolved” in acetic acid. Small, undissolved pieces will be removed byfiltering the thick slurry through cheesecloth. The filtrate will bediluted with 0.5M acetic acid and dialyzed against 0.5N acetic acidusing dialysis tubing having a 50,000 dalton nominal cut-off. Analternate dialysis method will utilize ultrafiltration/diafiltrationcartridges procured from Amersham Biotech. The dialysis process removespepsin and degraded pepsin. The retained liquid containing collagen willbe subjected to differential NaCl precipitation to isolate predominantlyType I collagen. Purified Type I collagen at about 5 mg/mL will be thendialyzed against 0.1N acetic acid to remove residual salts (about 5,000nominal molecular weight cut-off). The retained collagen solution willsubsequently be filtered through 0.45 μm and 0.2 μm filters and placedin sterile, 2-liter glass bottles. Collagen concentration will beapproximately 5 mg/mL. All steps will be conducted at room temperature.Stock solutions will be stored at 2-8° C.

Process Controls and Quality Control Tests: Final Stock Collagen Will beExamined by the Following Methods.

Analysis by SDS-PAGE to determine collagen purity;

Analysis of uronic acid to determine amounts of residualglycosaminoglycan

Assay of hydroxyproline to determine total collagen concentration;

Differential Scanning calorimetry to measure temperature of phasetransition (pure, undenatured telopeptide-poor collagen has a transitiononset of about 39° C.)

Sterility using USP methods

Endotoxin using LAL methods

Preparation of In Situ Gelling Collagen Solutions

Purified, pepsin-digested collagen will be precipitated by addition ofsolid NaCl to 0.8M. The resultant precipitate will be recovered bycentrifugation at 3500 RPM, a wet weight determined, and the precipitateplaced in dialysis tubing having a NMW cut-off of 50,000 Daltons.Attempts will be made to add enough precipitate to produce finalcollagen solutions at 30 and 50 mg/mL (3 and 5%). The tubing will beplaced in 20 volumes of 0.035M EDTA in deionized water, pH 5.0 anddialyzed with agitation for 24 hours. At this point, the dialysis tubingwill be transferred to another 20 volumes of 0.035 M EDTA, pH 5.5.Dialysis will be conducted again for 24 hours after which the tubingwill be placed in 0.035M EDTA, pH 6.0. This sequence will be continueduntil dialysis in a final EDTA solution at pH 7.5. This slow increase inpH during EDTA dialysis results in a collagen preparation that remains“soluble” at neutral pH. This is in contrast to standard collagensolutions that spontaneously undergo fibrillogenesis at neutral pH androom temperature. The neutral pH, EDTA-treated collagen solution willremain in solution during storage and will rapidly undergo gelation andfibril formation when exposed to physiological fluids.

Example 4 Use of ELISA-based Assay for Classical Complement PathwayActivation to Assess Complement Inhibiting Activity of CompstatinAnalogs

Materials:

-   -   Ninety six-well ELISA plate (Corning 3590)    -   Chicken OVA (Sigma A5378)    -   Polyclonal anti-chicken OVA (Abcam ab1221-100)    -   BSA 1% in PBS—Calbiochem #126626 1/30 dilution    -   Veronal Buffer+0.5 mM MgCl₂+0.15 mM CaCl₂ (VB⁺⁺)    -   Serum (collected with Lipirudin at 5 ug/ml final concentration)    -   Anti-human C3 HRP-conjugated Ab (Poly to C3-HRP Ab, Cappel        55237)    -   Tween-20 Wash Buffer (0.05% in PBS)    -   TMB (Peroxidase substrate)—1:1 mixture of BD 51-2607KC and        51-2606KC.    -   3M H₂SO₄    -   Micro-plate Reader

Protocol:

-   -   1. Add 50 ul/well of 1% chicken OVA (in PBS)    -   2. Incubate for 2 hours at room temp    -   3. Remove by shaking and tapping the plate.    -   4. Block by adding 200 ul of 1% BSA/PBS    -   5. Incubate for 1 h at room temp    -   6. Remove by shaking and tapping the plate    -   7. Add 50 ul of 1/1000 dilution of Polyclonal anti-chicken OVA        in 1% BSA/PBS    -   8. Incubate for 1 h at room temp    -   9. Wash twice with wash buffer    -   10. Add 50 ul VB⁺⁺ to wells #2 to 12    -   11. Add 100 ul of starting compound dilution (2× in VB⁺⁺) to        well 1.    -   12. Serially dilute (1:2) the compound from wells 1 to 10 as        follow        -   a. Take 50 ul of solution from the originating well        -   b. Add this to the next well        -   c. Mix by pipetting several times        -   d. Repeat up to well #10    -   Note: from well #10 remove 50 ul and discard.    -   13. Add 50 ul of 2× plasma dilution to wells 1 to 11    -   14. Incubate for 1 h    -   15. Wash twice with wash buffer    -   16. Add 50 ul of 1/1000 dilution of C3-HRP Ab in 1% BSA/PBS    -   17. Incubate for 1 h    -   18. Add 100 ul of TMB to all wells    -   19. Incubate for 30 min    -   20. Add 50 ul 3M H₂SO₄    -   21. Read the plate at 405 nm

VB⁺⁺

Formula:

Barbital   5 mM NaCl 72.5 mM MgCl₂  0.5 mM CaCl₂ 0.15 mM pH 7.3-7.4

Stock Solutions:

Veronal Buffer (5X) Prod # MW For 500 ml   9 mM Sodium Barbitone SigmaB0500 206.17  927 mg 15.5 mM diethylbarbituric acid Sigma B0375 184.191.42 grams

Mg—Cl2 (200X) Prod # MW For 50 ml 100 mM MgCl₂—6H₂O Sigma M0250 203.301.00 gram

CaCl₂ (500x) Prod # MW For 50 ml 75 mM EGTA Sigma C7902 147.01 551.28 mg

The above assay is performed using a variety of different compstatinanalogs. Percent inhibition may be normalized by considering 100%activation equal to activation occurring in the absence of compound orequal to activation occurring in the in the presence of an equal amountof an inactive variant of compstatin.

Example 5 Use of ELISA-Based Assay for Alternative Complement PathwayActivation to Assess Complement Inhibiting Activity of CompstatinAnalogs

Materials:

-   -   Ninety six-well ELISA plate (Corning 3590)    -   LPS from Salmonella typhosa—Sigma L7136 (40 ug/ml in PBS)    -   BSA 1% in PBS—Calbiochem #126626 1/30 dilution    -   Veronal Buffer+10 mM MgCl₂+10 mM EGTA (VB-Mg EGTA)    -   Serum (collected with Lepirudin at 5 ug/ml final concentration)    -   Anti-human C3 HRP-conjugated Ab (Poli to C3-HRP Ab, Cappel        55237)    -   Tween-20 Wash Buffer (0.05% in PBS)    -   TMB (Peroxidase substrate)—1:1 mixture of BD 51-2607KC and        51-2606KC.    -   3M H₂SO₄    -   Micro-plate Reader

Protocol:

-   -   22. Add 50 ul/well of LPS at 40 ug/ml (in PBS)    -   23. Incubate for 2 hours at room temp    -   24. Remove by shaking and tapping the plate.    -   25. Block by adding 200 ul of 1% BSA/PBS    -   26. Incubate for 1 h at room temp    -   27. Remove by shaking and tapping the plate    -   28. Add 50 ul VB-Mg EGTA to wells #2 to 12    -   29. Add 100 ul of starting compound dilution (2× in VB-Mg EGTA)        to well 1.    -   30. Serially dilute (1:2) the compound from wells 1 to 10 as        follow        -   a. Take 50 ul of solution from the originating well        -   b. Add this to the next well        -   c. Mix by pipetting several times        -   d. Repeat up to well #10    -   Note: from well #10 remove 50 ul and discard.    -   31. Add 50 ul of 2× plasma dilution to wells 1 to 11    -   32. Incubate for 1 h    -   33. Wash twice with wash buffer    -   34. Add 50 ul of 1/1000 dilution of C3-HRP Ab in 1% BSA/PBS    -   35. Incubate for 1 h    -   36. Add 100 ul of TMB to all wells    -   37. Incubate for 10 min    -   38. Add 50 ul 3M H₂SO₄    -   39. Read the plate at 405 nm

The above assay is performed using a variety of different compstatinanalogs. Percent inhibition may be normalized by considering 100%activation equal to activation occurring in the absence of compound orequal to activation occurring in the in the presence of an equal amountof an inactive variant of compstatin.

EQUIVALENTS AND SCOPE

Those skilled in the art will recognize, or be able to ascertain usingno more than routine experimentation, many equivalents to the specificembodiments of the invention described herein. The scope of the presentinvention is not intended to be limited to the above Description, butrather is as set forth in the appended claims. It will be appreciatedthat the invention is in no way dependent upon particular resultsachieved in any specific example or with any specific embodiment. In theclaims articles such as “a,”, “an” and “the” may mean one or more thanone unless indicated to the contrary or otherwise evident from thecontext. Claims or descriptions that include “or” between one or moremembers of a group are considered satisfied if one, more than one, orall of the group members are present in, employed in, or otherwiserelevant to a given product or process unless indicated to the contraryor otherwise evident from the context. The invention includesembodiments in which exactly one member of the group is present in,employed in, or otherwise relevant to a given product or process. Forexample, and without limitation, it is understood that where claims ordescription indicate that a residue at a particular position may beselected from a particular group of amino acids or amino acid analogs,the invention includes individual embodiments in which the residue atthat position is any of the listed amino acids or amino acid analogs.The invention also includes embodiments in which more than one, or allof the group members are present in, employed in, or otherwise relevantto a given product or process. Furthermore, it is to be understood thatthe invention encompasses all variations, combinations, and permutationsin which one or more limitations, elements, clauses, descriptive terms,etc., from one or more of the listed claims is introduced into anotherclaim. In particular, any claim that is dependent on another claim canbe modified to include one or more elements or limitations found in anyother claim that is dependent on the same base claim. Furthermore, wherethe claims recite a composition, it is to be understood that methods ofadministering the composition according to any of the methods disclosedherein, and methods of using the composition for any of the purposesdisclosed herein are included, and methods of making the compositionaccording to any of the methods of making disclosed herein are included,unless otherwise indicated or unless it would be evident to one ofordinary skill in the art that a contradiction or inconsistency wouldarise.

Where elements are presented as lists, e.g., in Markush group format, itis to be understood that each subgroup of the elements is alsodisclosed, and any element(s) can be removed from the group. Forpurposes of conciseness only some of these embodiments have beenspecifically recited in haec verba herein, but the invention includesall such embodiments. It should also be understood that, in general,where the invention, or aspects of the invention, is/are referred to ascomprising particular elements, features, etc., certain embodiments ofthe invention or aspects of the invention consist, or consistessentially of, such elements, features, etc.

The inclusion of a “providing” step in certain methods of the inventionis intended to indicate that the composition is administered to treat aneye disorder. Thus the subject will have or be at risk of an eyedisorder and the composition is administered to treat the disorder,typically upon the sound recommendation of a medical or surgicalpractitioner, e.g., an ophthalmologist, who may or may not be the sameindividual who administers the composition. The invention includesembodiments in which a step of providing is not explicitly included andembodiments in which a step of providing is included. The invention alsoincludes embodiments in which a step of identifying the subject as beingat risk of or suffering from an eye disorder characterized by maculardegeneration, CNV, RNV, proliferative retinopathy, diabetic retinopathy,glaucoma, ocular inflammation, or any combination of these, is included.

Where ranges are given, endpoints are included. Furthermore, it is to beunderstood that unless otherwise indicated or otherwise evident from thecontext and understanding of one of ordinary skill in the art, valuesthat are expressed as ranges can assume any specific value or subrangewithin the stated ranges in different embodiments of the invention, tothe tenth of the unit of the lower limit of the range, unless thecontext clearly dictates otherwise.

In addition, it is to be understood that any particular embodiment ofthe present invention that falls within the prior art may be explicitlyexcluded from any one or more of the claims. Since such embodiments aredeemed to be known to one of ordinary skill in the art, they may beexcluded even if the exclusion is not set forth explicitly herein. Anyparticular embodiment of the compositions of the invention (e.g., anyparticular compound), any method of administration, any eye disorder orcondition or characteristic(s) thereof, or any subject characteristic(s)can be excluded from any one or more claims.

1. A method of treating an eye disorder characterized by maculardegeneration, choroidal neovascularization, retinal neovascularization,proliferative vitreoretinopathy, glaucoma, ocular inflammation, or anycombination of these, comprising the step of: administering acomposition comprising an effective amount of a compstatin analog to asubject at risk of or suffering from the eye disorder. 2.-4. (canceled)5. The method of claim 1, wherein the compstatin analog is a compoundthat comprises a cyclic peptide having a core sequence ofX′aa-Gln-Asp-Xaa-Gly (SEQ ID NO: 3), where X′aa and Xaa are selectedfrom Trp and analogs of Trp.
 6. The method of claim 1, wherein thecompstatin analog is a compound that comprises a cyclic peptide having acore sequence of X′aa-Gln-Asp-Xaa-Gly-X″aa (SEQ ID NO: 4), where X′aaand Xaa are each independently selected from Trp and analogs of Trp andX″aa is selected from His, Ala, single methyl unbranched amino acids,Phe, Tip, and analogs of Trp.
 7. The method of claim 6, wherein thepeptide has a sequence ofX′aa1-X′aa2-X′aa3-X′aa-Gln-Asp-Xaa-Gly-X″aa-X″aa2-X″aa3-X″aa4-X″aa5 (SEQID NO: 5), and X′aa1, X′aa2, X′aa3, X″aa2, X″aa3-X″aa4, and X″aa5 areidentical to the amino acids at the corresponding positions incompstatin.
 8. The method of claim 1, wherein the compstatin analog is acompound that comprises a cyclic peptide having a sequence ofX′aa1-X′aa2-X′aa3-X′aa4-Gln-Asp-Xaa-Gly-X″aa1-X″aa2-X″aa3-X″aa4-X″aa-5(SEQ ID NO: 5), where X′aa4 and Xaa are selected from Trp and analogs ofTrp, wherein X′aa1, X′aa2, X′aa3, X″aa1, X″aa2, X″aa3, X″aa4, and X″aa5are independently selected from among amino acids and amino acidanalogs, and the peptide is cyclized via a bond between X′aa2 and X″aa4.9. (canceled)
 10. The method of claim 1, wherein the compstatin analogis a compound that comprises a cyclic peptide having a sequence:Xaa1-Cys-Val-Xaa2-Gln-Asp-Xaa2*-Gly-Xaa3-His-Arg-Cys-Xaa4 (SEQ ID NO:6); wherein: Xaa1 is Ile, Val, Leu, B₁-Ile, B₁-Val, B₁-Leu or adipeptide comprising Gly-Ile or B₁-Gly-Ile, and B₁ represents a firstblocking moiety; Xaa2 and Xaa2* are independently selected from Trp andanalogs of Trp; Xaa3 is His, Ala or an analog of Ala, Phe, Tip, or ananalog of Trp; Xaa4 is L-Thr, D-Thr, Ile, Val, Gly, a dipeptide selectedfrom Thr-Ala and Thr-Asn, or a tripeptide comprising Thr-Ala-Asn,wherein a carboxy terminal —OH of any of the L-Thr, D-Thr, Ile, Val,Gly, Ala, or Asn optionally is replaced by a second blocking moiety B₂;and the two Cys residues are joined by a disulfide bond.
 11. The methodof claim 10, wherein the peptide is acetylated at the N-terminus,amidated at the C-terminus, or both acetylated at the N-terminus andamidated at the C-terminus.
 12. The method of claim 10, wherein Xaa1 isIle, Val, Leu, Ac-Ile, Ac-Val, Ac-Leu or a dipeptide comprising Gly-Ileor Ac-Gly-Ile; Xaa2 and Xaa2* are independently selected from Trp andanalogs of Trp; Xaa3 is His, Ala or an analog of Ala, Phe, Trp, or ananalog of Trp; Xaa4 is L-Thr, D-Thr, Ile, Val, Gly, a dipeptide selectedfrom Thr-Ala and Thr-Asn, or a tripeptide comprising Thr-Ala-Asn,wherein a carboxy terminal—OH of any of the L-Thr, D-Thr, Ile, Val, Gly,Ala, or Asn optionally is replaced by—NH₂.
 13. The method of claim 10,wherein Xaa2 is an analog of Tip having increased hydrophobic characterrelative to Trp.
 14. The method of claim 10, wherein Xaa2 is an analogof Trp comprising a substituted or unsubstituted bicyclic aromatic ringcomponent or two or more substituted or unsubstituted monocyclicaromatic ring components. 15.-22. (canceled)
 23. The method of claim 1,wherein the composition is administered intravitreally. 24.-126.(canceled)
 127. A method of identifying compstatin mimetics for use intreatment of eye disorders characterized by macular degeneration,choroidal neovascularization, retinal neovascularization, ocularinflammation, or combinations thereof, the method comprising: providingone or more test compounds or molecular structures thereof; identifyinga candidate compstatin mimetic by selecting one or more of the testcompounds or structures thereof that binds to substantially the sameregion of human C3 as does compstatin; and determining C3-inhibitoryactivity of the candidate compstatin mimetic.
 128. The method of claim127, wherein the method comprises computationally docking one or more ofthe molecular structures with the three-dimensional structure of C3 or aportion thereof; and selecting a molecular structure that formssubstantially the same intermolecular contacts with the C3-binding siteas does compstatin.
 129. The method of claim 127, wherein the methodcomprises identifying the candidate compstatin mimetic as a compstatinmimetic for use in treatment of eye disorders characterized by maculardegeneration, choroidal neovascularization, retinal neovascularization,ocular inflammation, or combinations thereof if the C3-inhibitoryactivity of the candidate compstatin analog is at least as great as thatof compstatin.
 130. The method of claim 127, further comprisingadministering the compstatin mimetic to an animal that serves as a modelof an eye disorder characterized by macular degeneration, choroidalneovascularization, retinal neovascularization, ocular inflammation, orcombinations thereof.
 131. A method of identifying a compstatin mimeticthat binds to C3 for use in treatment of eye disorders characterized bymacular degeneration, choroidal neovascularization, retinalneovascularization, ocular inflammation, or combinations thereof, themethod comprising comprising: providing a three-dimensional structure ofcompstatin or a compstatin analog bound to C3 or a portion thereof;computationally docking one or more molecular structures with theC3-binding site of compstatin or a compstatin analog in athree-dimensional structure of C3 or a portion thereof; and selectingone or more molecular structures that form substantially the sameintermolecular contacts with the C3-binding site as compstatin or thecompstatin analog, thereby identifying a candidate compstatin mimetic.132. The method of claim 131, further comprising determiningC3-inhibitory activity of the candidate compstatin mimetic.
 133. Themethod of claim 131, further comprising administering the compstatinmimetic to an animal that serves as a model of an eye disordercharacterized by macular degeneration, choroidal neovascularization,retinal neovascularization, ocular inflammation, or combinationsthereof.